Background: Disadvantaged social, economic, and environmental factors create Adverse Childhood Experiences (ACEs), which can harm a child’s developing brain and have lasting effects on health. These experiences range from physical, emotional, or sexual abuse to parental divorce or substance abuse. Afflicted children have a significantly increased risk of behavioral and health issues later in childhood, as well as adult onset chronic health problems. We hypothesize that primary care ACEs screening, intervention by a primary care-behavior health care integrated care team, and referrals for parenting support and resources will be feasible, acceptable, and beneficial from parent and provider perspectives. Methods: Parents with an ACE score of four or higher at the one-month checkup will be offered The Incredible Years interactive video intervention during checkups through 9 months of age. Parents or children with an ACE score of four or higher at the 1-4 year well child visits will be referred to participate in Nurturing Parenting group visits provided by a partnering community agency. Both programs are evidence-based, family-centered trauma-informed programs supporting positive child rearing practices. Process and outcome variables will be assessed using surveys administered after patient screening and following each program session, and primary care providers will be surveyed at the end of the project period. Process and outcome measures include; number of families screened for ACEs, number referred to parenting programs, the number of program sessions completed and attendance and changes in selfassessed parenting competence. This study will demonstrate the feasibility of integrating traumainformed practices into primary pediatric care, document an increase in referrals to community support services and document an increase in self assessed parenting competence among parents who have suffered 4 or more ACEs. Results: Preliminary survey results show that families evaluate the process of undergoing ACEs screening and follow up discussion with providers in a favorable manner. Additionally, families with elevated ACEs scores that meet criteria for additional interventions, received the corresponding program in as acceptable and appropriate. Provider surveys are forthcoming, however the additional screening, intervention provided by the Behavioral Health Team, and feasibility survey collection has not affected the clinic’s productivity or delayed patient care. Upon initially starting screening and survey administration at clinic, an error was noted in the reporting of ACEs screening results in the EMR. Data collection was delayed while the EMR function was edited by IT administrator. Conclusions: Our multidisciplinary team will continue to collect data and continue to evaluate and streamline all aspects of the project in order to enhance the care of our patients and families. Additionally, will evaluate concerns and recommendations noted with provider administration survey at conclusion of data collection.

No description available.

Introduction: Breastfeeding has numerous benefits for babies, mothers, and families. It is well established that mothers perceptions of embarrassment, convenience, and social support related to breastfeeding affect whether they choose to breastfeed and for how long . Tennessee falls well below national statistics and goals for breastfeeding initiation and continuation. Effective and efficient promotional tools that can be incorporated into clinical care are needed. Objectives: This study evaluated the effectiveness of a video intervention to improve perceptions of breastfeeding among pregnant women presenting for a prenatal visit in an obstetrics and gynecology (OB/GYN) clinic in northeast Tennessee. Specifically, the project sought to determine whether watching the video with the babys father, a friend, or family member (supportive others) would be more beneficial than watching it alone, a previously unanswered question. Methods: The investigative team established a relationship with an OB/GYN clinic that serves a high volume of pregnant women. A 15 minute video addressing issues of embarrassment, convenience and support related to breastfeeding was shown in the clinic waiting room. The video had been previously developed and evaluated by the Mississippi Department of Health. Pregnant women visiting the clinic during 8 days in 2009 were invited to complete an anonymous written survey immediately before and after viewing the video. The survey included items on demographics, perceptions of breastfeeding, and intention to breastfeed. Descriptive statistics were calculated. The proportion of women reporting improved perceptions of breastfeeding was compared between subgroups using chi-square testing. Mean breastfeeding perception scores were compared between subgroups and changes in womens intention to breastfeed were evaluated. Results: Of the 77 participants, 38.9% reported previously breastfeeding a child, 51.3% planned to breastfeed, and 25% were undecided. After viewing the video, perceptions of embarrassment, convenience, and social support related to breastfeeding improved in a range of 39-44.2%, 37-40%, 39-63% of women, respectively. Mothers who watched the video with a supportive other were more likely to report improved perceptions of embarrassment than mothers who watched the video alone (chi2 = 12.01, p = .002). Of the mothers who reported being undecided about breastfeeding prior to watching the video, 57.9% reported being more likely to breastfeed after watching the video (chi2=10.22, df=2, p=0.006). Discussion: The findings suggest this video intervention is an effective means of addressing barriers to breastfeeding in the clinical setting. Furthermore, this study addressed previously unanswered questions about the impact of pregnant mothers watching the video with supportive others; results indicate that its efficacy is significantly improved if pregnant women view it with a supportive other.

Polypharmacy entails the use of multiple drugs taken at the same time to manage the various comorbidities common among elderly patients. Polypharmacy is associated with increased health care spending due to drug duplication, adverse drug events, and medication noncompliance. Medication reconciliation has been shown to reduce the problems seen with polypharmacy. The purpose of this project was to review published evidence to develop a staff education program on medication reconciliation in a primary care setting and determine the efficacy of the program in relation to staff confidence and knowledge levels concerning medication reconciliation. The project was guided by Nola Pender's health promotion model. The education program was modeled after a medical staff education program on medication reconciliation and included a medication assessment questionnaire and its use when evaluating a patient's medications. The pretest and posttest questionnaire obtained from the education materials was administered to clinical staff at the practice site before and after presenting the education material. Data were analyzed for statistical changes after the education program using a t test. Results showed that participants increased their confidence and knowledge of medication reconciliation from an average score of 2.19 (SD 0.20) before the education to 4.37 (SD 0.12) (p < 0.001) on a 5-point confidence scale after the education. This staff education program will promote positive social change by increasing nurses' knowledge and confidence of medication reconciliation and potentially reducing the incidence of polypharmacy and its negative effects among the elderly patients.

No description available.