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Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed behavior disorder in children. With the frequency of ADHD diagnoses, primary care providers (PCP) are challenged with managing this chronic and complex concern in an efficient yet effective way, both in terms of time and money. Research indicates behavioral diagnoses and management take approximately five minutes longer than medical-only concerns. This can result in a revenue loss for primary care practices. However, an on- site behavioral health consultant (BHC) can help PCPs provide a high standard of care for children presenting with behavioral concerns without compromising cost effectiveness. This study’s aim was to assess the cost per minute in a small rural primary care practice that utilizes an on-site BHC by comparing data between ADHD appointments when the BHC was utilized versus ADHD appointments when the BHC was not utilized. This study used extant data consisting of a sample of 53 children with ICD-9-CM codes 314.00 or 314.01, indicating an ADHD diagnosis. Of the 53 children with these codes, 40 (75.5%) were billed using E/M codes 99213 or 99214. The first of these indicates a regular office visit with an established patient not exceeding 15 minutes while the latter is used if the visit lasts longer than 25 minutes. Both codes were combined and evaluated together. The database was then recoded to indicate whether or not a BHC was utilized. Using descriptive statistics, it was found that children with ADHD spent a max of 69 minutes (20.19 minutes on average) with the PCP when a BHC was not utilized and a max of 22 minutes (13.67 minutes on average) when a BHC was utilized. Furthermore, an average of $82.79 in insurance reimbursement was received by the practice for these types of visits, regardless of up-coding for physician time spent. Using these statistics, it was determined that the practice makes $4.10 per minute when a BHC is not utilized versus $6.06 per minute when a BHC is utilized for ADHD appointments, due to the time savings ratio. The results indicate that utilization of a BHC increases revenue with respect to minutes spent with the child, while still providing behavioral health time and attention to the patient. These findings have practical implications for the treatment and management of ADHD and support the use of BHCs in pediatric primary care settings. Given the nature of pediatric primary care, it would be more cost effective for PCPs to utilize an on-site BHC with all ADHD visits.

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This preliminary study examined the relation between weight and parent-reported psychosocial concerns among youth presenting to pediatric primary care clinics serving rural Appalachia. Parents of youth presenting for a sick or well child visit completed a demographic questionnaire and the Pediatric Symptom Checklist in the waiting area prior to their office visit. Standardized body mass index (zBMI) were computed based on information retrieved. Psychosocial concerns, specifically attention difficulties, were found to be significantly and negatively correlated with zBMI. Higher zBMI was found in youth with clinically significant (versus non-significant) internalizing scores and clinically non-significant (versus significant) attention difficulty scores. Additional research is needed to understand the complex relationship between weight and psychosocial concerns among youth presenting to rural pediatric primary care. An understanding of the relation between these factors may facilitate prevention/intervention efforts.

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Introduction: Nearly 60,000 children receive emergency services each year due to accidental medication ingestion. Since families regularly receive verbal anticipatory guidance about locking up medications during pediatric well child visits, primary care clinics are an opportune place to distribute lock boxes to families who need them. ETSU Pediatrics is an interprofessional outpatient clinic that serves a population with many social, medical, and psychological needs. ETSU Pediatrics partnered with a local non-profit organization to provide medication lock boxes free to charge to families who need one. However, it was not known whether more families would endorse a need for a lock box in response to a systematic effort to screen for this need. We hypothesized that more medication lock boxes would be administered if families were given a written screener asking explicitly about their need for a lock box. Method:ETSU Pediatrics added the question “To increase child safety, is your household in need of a lockbox for medications?” to an existing social determinants of health screener that is given annually to each patient during their well child visit. Social work students imbedded in the clinic gave out lock boxes to families who endorsed a need. Frequency counts of the number of medication lock boxes given out were compared 6 months before and after the initiation of the screener. Results: Out of the 2,018 well child visits that occurred in the 6 months after screener initiation, 5.5% (111) of families endorsed a need for a medication lock box. Of those 106 were given a lock box. This was a substantial increase in demand for lock boxes compared to the 6 months prior to screener initiation in which only 16 lock boxes were given out. Conclusions: Systematic screening for medication lock box need resulted in more lock boxes being administered to families over a 6-month period, compared to care as usual. An embedded interprofessional student team helped facilitate this process. These results show promise for other healthcare organizations aimed at reducing accidental medication ingestions in children.

Bakgrund: Barn som far illa är ett ökande samhällsproblem som kan ge konsekvenser för barns hälsa. BHV-sjuksköterskan har möjlighet att upptäcka barn som far illa. Enligt socialtjänstlagen finns en skyldighet att anmäla, trots det visar tidigare forskning att det kan upplevas svårt och att riktlinjer kan behöva förtydligas. Syfte: Syftet med studien var att belysa BHV-sjuksköterskans erfarenheter av orosanmälningar vid misstanke om att barn far illa. Metod: Semistrukturerade intervjuer genomfördes med nio BHV-sjuksköterskor i Halland. Dataanalysen utgick från Kvalitativ innehållsanalys enligt Graneheim och Lundman (2017). Resultat: BHV-sjuksköterskornas erfarenheter kategoriserades i tre huvudkategorier; Att ta beslutet, Organisatorisk påverkan, Föräldrarnas påverkan. Konklusion: Studien belyser beslutet kring en orosanmälan som komplext och känsloladdat. Rutiner, riktlinjer, teamarbete och stöd från chefen beskrevs vara viktigt. Förbättrade rutiner skulle kunna leda till att fler barn som far illa upptäcks. Brister i samarbetet med socialtjänsten framkom som försvårande. Bemötandet av föräldrarna var viktigt för relationen och negativa reaktioner från föräldrarna kunde försvåra att göra orosanmälningar. Vidare forskning från föräldrarnas perspektiv samt djupare undersökning av samverkan med socialtjänsten skulle behövas. / Background: Children who are victims of maltreatment is an increasing society problem, which can have consequences for children’s health. Pediatric primary nurses have an opportunity to detect these children. According to the law there is an obligation to report when maltreatment is suspected. Research has shown that it can be difficult and that improved guidelines is needed. Aim: The aim of this study was to describe pediatric primary nurses’ experience of mandatory reports if children are suspected to be victims of maltreatment. Method: Semi-structured interviews have been conducted with nine pediatric primary nurses in Halland. The data analysis was based on Qualitative content analysis (Graneheim and Lundman, 2017). Results: Three main categories were identified; To make the decision, Organisational involvement, The parents’ involvement. Conclusion: The study highlights the decision regarding a mandatory report as complex and emotional. Routines, guidelines, teamwork and support from the employer are described as important. Improved routines could make it easier discovering child maltreatment. Shortcomings in the cooperation with social services emerged as obstructing. The reception of the parents was important and negative reactions could make mandatory reports difficult. Research of the parent’s perspective, and investigation into the cooperation with the social services, is needed.