Policies Protecting Children and a Portal for Parents and Teachers

Portals and policies lead the headlines this week in our Friday roundup of research news from The Children’s Hospital of Philadelphia. A new state law to keep babies and toddlers safe in cars takes effect in Pennsylvania today, and a CHOP expert was on hand for a video about it that went viral. CHOP research and collaboration with policymakers have taken effect with a new hotline to help physicians avoid overprescribing psychotropic drugs to children with behavioral health problems. And an electronic portal is showing some promise and pitfalls for connecting parents, teachers, and pediatricians to coordinate children’s care. Check out the details below.

New Rear-Facing Car Seat Law in Pennsylvania Draws on CHOP Expertise, Draws Laughs

A new child safety law takes effect in Pennsylvania today. Children in Pennsylvania are now required to ride in rear-facing car seats until age 2. Rear-facing car seats better protect a small child’s head and spine in the event of a crash.

As Newsworks reported, the new law follows guidelines issued by the American Academy of Pediatrics (AAP) in 2011.

“I think it’s confusing to families when the law says something different than their doctors say or the law says something different than the federal government says," Dennis Durbin, MD, MSCE, assistant vice president and chief clinical research officer at CHOP, who was lead author of the AAP policy, told the news outlet. "And so I like these opportunities to align the laws with the best practice recommendations.”

Word about the new law seems to be spreading far and wide thanks to a FOX 29 TV news segment that went viral. An uncooperative toddler wanted no part in the rear-facing car seat demonstration, while CHOP injury prevention specialist Gina Duchossois rallied to deliver the key safety details that parents need to know. Watch the segment here.

Pediatricians Give Teachers Homework in Test of ADHD Care-Coordination Portal

Teachers and parents both had homework assignments to complete during a feasibility test of a new electronic portal designed to improve communication about attention-deficit/hyperactivity disorder (ADHD). Researchers in PolicyLab at CHOP developed the tool as a potential way to overcome the fact that the two systems most involved in children’s ADHD treatment — primary care pediatricians and schools — are often disconnected from each other.

“To overcome this barrier, we developed an electronic portal through which parents and teachers of children with ADHD can complete ADHD rating scales and share them with the child’s primary care pediatrician,” wrote Stephanie Mayne, MHS, a member of the research team. “Surveys are completed online, and email reminders are sent to parents and teachers at intervals set by the child’s clinician. Results of the surveys are then displayed directly in the child’s electronic health record.”

Mayne described the result of the team’s feasibility testing of the portal with 105 primary care pediatricians and nurse practitioners at 19 CHOP practices. Overall, about two out of three pediatricians used the portal with at least one patient, and one in three used it with at least five patients. The team identified a number of barriers that limited the tool’s use by parents and teachers.

“Although we focused primarily on ADHD, the principles and strategies discussed in our study are applicable to a range of behavioral and emotional conditions for which obtaining multi-system information and input is beneficial,” Mayne wrote on the PolicyLab blog. “When considering implementation in the clinical setting, these findings highlight the importance of considering office workflow when implementing changes in primary care practices, and indicate a need to simplify the process of signing up parents and teachers to use electronic systems.”

The study’s findings appeared in the journal Advances in School Mental Health Promotion.

Hotline Helps Doctors Find Alternatives to Overprescribing Psychotropic Drugs

As we reported earlier this year, PolicyLab research commissioned by the Pennsylvania Department of Human Services (DHS) has shown that the use of psychotropic medications was three times higher among 6 to 18-year-olds in foster care than among youth in Medicaid overall. More than half of youth antipsychotic users in Medicaid had a diagnosis of ADHD. The majority of these youth did not have another diagnosis that clinically indicated the use of antipsychotics. This is a significant concern because these drugs can have side effects, and they should be prescribed under careful consideration and subject to ongoing monitoring over time.

In response to PolicyLab’s research and analysis, DHS partnered with experts from CHOP, the AAP, and the Pennsylvania Psychiatric Society last year to start taking a serious look at psychotropic prescribing practices for children. One of the steps developed to address the issue in the resulting action plan has now come to fruition: a telephone hotline to assist medical clinicians when prescribing psychotropic medications for children.

David Rubin, MD, MSCE, director of PolicyLab and a CHOP pediatrician who has been involved in these efforts, told Newsworks that doctors can use the hotline to discuss alternative treatment options and get second opinions about complex cases.

"I think families and clinicians often feel helpless because they don't know what services kids might have access to that could be an alternative," Dr. Rubin said.

CHOP is facilitating the hotline service in southeastern Pennsylvania. Read more about the new hotline at Newsworks and more about the statewide action plan in Bench to Bedside.

ICYMI

In case you missed it earlier this week on Cornerstone, we brought you a conversation about clinical research that covered everything from poop to picture books. To get a look inside what families and clinical research coordinators experience, check out the Q&A here.

Last week’s In the News post covered a behavioral intervention that helped entire classrooms of kids embrace friendlier behavior, a call for pediatric research ideas in office settings, an inspiring clinical research participant, and awareness activities for breastfeeding and vaccines.

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