<p><strong>OBJECTIVE: </strong>To determine feasibility and explore effects of literacy promotion using e-books vs. board books on the home reading environment, book reading, television use, and child development.</p>

<p><strong>METHODS: </strong>Randomized controlled trial comparing digital literacy promotion (DLP) using e-books to standard literacy promotion (SLP) using board books among Medicaid-eligible infants. DLP participants received e-books on home digital devices, while SLP participants received board books at well visits between 6-12 months of age. Differences in StimQ Read Subscale (StimQ-Read) scores, parent-reported reading and television use, and Bayley Scales of Infant Development-3 Edition (Bayley-3) scores between groups were assessed using intention-to-treat analysis.</p>

<p><strong>RESULTS: </strong>104 Medicaid-eligible infants were enrolled and randomized from 3 pediatric practices. There were no differences in socio-demographic characteristics between groups at baseline. Children in the DLP group initially had lesser StimQ-Read scores but showed similar increases in StimQ-Read scores over time as children in the SLP group. Parents in the DLP group reported greater use of digital devices to read or engage their child (65% vs. 23%, p&lt;0.001) but similar board book reading and television viewing. There were no differences between groups in cognitive or motor scale scores, but DLP participants had marginally lower language scales scores (DLP 85.7 vs. SLP 89.7; p=0.10) at the 6-month follow-up.</p>

<p><strong>CONCLUSIONS/DISCUSSION: </strong>Literacy promotion using e-books was feasible and associated with greater e-book usage but no difference in board book reading, television viewing, or home reading environment scores. A potential adverse impact of e-books on language development should be confirmed in future study.</p>

<p><strong>TRIAL REGISTRATION: </strong>Clinicaltrials.gov Identifier NCT03121365.</p>

<p><strong>OBJECTIVE: </strong>Literacy promotion is a pediatric standard of care in which clinicians provide guidance on shared reading. Latino parents are more likely to hear advice to read with children but are less likely to do so. We sought to understand literacy promotion from the perspective of Latino parents and to identify facilitators and barriers.</p>

<p><strong>METHODS: </strong>We purposively sampled Latino parents who participated in Reach Out and Read (ROR) for a qualitative, semi-structured interview study. We identified themes using immersion/crystallization and achieved thematic saturation after 21 interviews.</p>

<p><strong>RESULTS: </strong>Two-thirds of participants had less than high school education; half of whom had not completed 8th grade. The mean child age was 16.4 months. Primary facilitators of engagement were advice from a pediatrician during a clinical encounter and receipt of the ROR book. Barriers identified included: (1) parents' perceptions that their children were not developmentally ready and that their children's behavior (e.g., activity) indicated they were not interested in shared reading; (2) self-perceived limited literacy and/or English proficiency; (3) parenting demands occurring in the context of poverty; and (4) continued child media use despite advice from pediatricians to choose alternate activities such as shared reading instead.</p>

<p><strong>CONCLUSIONS: </strong>Parent-clinician relationships are central to ROR's impact but clinicians need to pay more attention to factors in a child's broader environment to strengthen literacy promotion. Specifically clinicians should emphasize skill building during the clinical encounter (e.g., sharing knowledge about child development and modeling) and work collaboratively with other stakeholders to address poverty-related stressors.</p>

<p><strong>BACKGROUND: </strong>Access to written hospital discharge instructions improves caregiver understanding and patient outcomes. However, nearly half of hospitals do not translate discharge instructions, and little is known about why.</p>

<p><strong>OBJECTIVES: </strong>To identify barriers to and potential strategies for translating children's hospital discharge instructions.</p>

<p><strong>METHODS: </strong>We conducted a mixed-methods, multimodal analysis. Data comprised closed- and open-ended responses to an online survey sent to Children's Hospital Association language services contacts ( = 31), an online environmental scan of Children's Hospital Association translation policies ( = 22), and county-level census data. We examined quantitative data using descriptive statistics and analyzed open-ended survey responses and written policies using inductive qualitative content analysis.</p>

<p><strong>RESULTS: </strong>Most survey respondents (81%) reported having a written translation policy at their hospital, and all reported translating a subset of hospital documents, for example, consent forms. Most but not all reported translating discharge instructions (74%). When asked how inpatient staff typically provide translated discharge instructions, most reported use of pretranslated documents (87%) or staff interpreters (81%). Reported barriers included difficulty translating uncommon languages, mismatched discharge and translation time frames, and inconsistent clinical staff use of translation services. Strategies to address barriers included document libraries, pretranslated electronic health record templates, staff-edited machine translations, and sight translation. Institutional policies differed regarding the appropriateness of allowing interpreters to assist with translation. Respondents agreed that machine translation should not be used alone.</p>

<p><strong>CONCLUSIONS: </strong>Children's hospitals experience similar operational and organizational barriers in providing language-concordant discharge instructions. Current strategies focus on translating standardized documents; collaboration and innovation may encourage provision of personalized documents.</p>

<p>Many young children identified with developmental concerns in pediatric settings do not receive early intervention (EI). We assessed the impact of a video decision aid and text message reminder on knowledge and attitudes regarding developmental delay and EI as well as referral completion. We conducted a pilot randomized controlled trial in an urban setting and enrolled 64 parent-child dyads referred to EI. Compared with controls, participants who received the intervention demonstrated increased knowledge regarding developmental delay and EI as well as more favorable attitudes in certain topics. Although we did not find a significant difference between arms in EI intake and evaluation, we found a pattern suggestive of increased intake and evaluation among participants with low health literacy in the intervention arm. Additional study is needed to identify strategies that improve the EI referral process for families and to understand the potential targeted role for decision aids and text messages.</p>

<p>Over 90% of children with chronic conditions survive into adulthood necessitating primary care teams to care for adults with pediatric-onset chronic conditions. This study explores practice supports and barriers to care for this population via qualitative techniques. Using in depth interviews with twenty-two healthcare providers practice supports identified include: formalizing intake processes, interoperable electronic medical records, and leveraging care coordination. Barriers identified included: definition of the medical team, lack of appropriate medical records, time and administrative burden, lack of training, and financial constraints. Themes may be utilized to design interventions and improve care coordination for patients with pediatric-onset chronic conditions.</p>

<p><strong>OBJECTIVE: </strong>To explore barriers to early intervention (EI) evaluation among referred infants and toddlers.</p>

<p><strong>METHODS: </strong>We conducted semistructured interviews with parents of children referred for EI services and with EI staff. We purposively sampled families according to whether they received an EI evaluation. Families were recruited from a randomized controlled trial testing implementation of developmental screening. Parents filled out demographic surveys. Interviews were recorded, transcribed, and coded. We identified themes within and across respondent groups using modified grounded theory.</p>

<p><strong>RESULTS: </strong>We reached thematic saturation after interviewing 22 parents whose child was evaluated by EI, 22 not evaluated, and 14 EI employees. Mean child age at first referral was 16.7 months, and 80% were referred as the result of language concerns. We identified 5 primary themes: (1) Parents reported communication problems with their pediatrician, including misinterpreting reassurance and not understanding the referral process; (2) Many parents saw themselves as experts on their child's development and felt they should decide whether their child pursues EI services; (3) Some families preferred to wait for the developmental concern to resolve or work with their child on their own prior to seeking EI services; (4) For ambivalent parents, practical obstacles especially limited completion of evaluation, but highly motivated parents overcame obstacles; and (5) EI employees perceived that families avoid evaluation because they mistake EI for child protective services.</p>

<p><strong>CONCLUSIONS: </strong>Communication between pediatricians and families that addresses practical logistics, families' perceptions of their child's development and EI, and motivation to address developmental concerns may improve the completion of EI referrals.</p>

<p><strong>OBJECTIVE: </strong>To identify parent, child, community, and health care provider characteristics associated with early intervention (EI) referral and multidisciplinary evaluation (MDE) by EI.</p>

<p><strong>METHODS: </strong>We conducted a mixed methods secondary analysis of data from a randomized controlled trial of a developmental screening program in 4 urban primary care practices. Children &lt;30 months of age not currently enrolled in EI and their parents were included. Using logistic regression, we tested whether parent, child, community, and health care provider characteristics were associated with EI referral and MDE completion. We also conducted qualitative interviews with 9 pediatricians. Interviews were recorded, transcribed, and coded. We identified themes using modified grounded theory.</p>

<p><strong>RESULTS: </strong>Of 2083 participating children, 434 (21%) were identified with a developmental concern. A total of 253 children (58%) with a developmental concern were referred to EI. A total of 129 children (30%) received an MDE. Failure in 2 or more domains on developmental assessments was associated with EI referral (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.89-5.24) and completed MDE (AOR 2.16, 95% CI 1.19-3.93). Faxed referral to EI, as opposed to just giving families a phone number to call was associated with MDE completion (AOR 2.94, 95% CI 1.48-5.84). Pediatricians reported that office processes, family preference, and whether they thought parents understood the developmental screening tool influenced the EI referral process.</p>

<p><strong>CONCLUSIONS: </strong>In an urban setting, one third of children with a developmental concern were not referred to EI, and two thirds of children with a developmental concern were not evaluated by EI. Our results suggest that practice-based strategies that more closely connect the medical home with EI such as electronic transmission of referrals (e.g., faxing referrals) may improve completion rates of EI evaluation.</p>

<p><strong>OBJECTIVE: </strong>To compare parents' experience with the early intervention (EI) referral process based on health literacy level.</p>

<p><strong>METHODS: </strong>We interviewed 44 parents of children referred to EI by their pediatricians. Parents completed the Newest Vital Sign (NVS) health literacy assessment. We analyzed transcripts using modified grounded theory and compared themes based on health literacy.</p>

<p><strong>RESULTS: </strong>Forty parents completed the NVS. Twenty-eight (70%) had adequate health literacy. Four primary themes differed between parents based on health literacy level. Parents with low health literacy commonly reported that: (1) they lacked continuity with a single pediatrician, (2) they had difficulty contacting EI, (3) they were confused about EI or the referral process (4) their pediatricians did not explain EI and written materials were not helpful.</p>

<p><strong>CONCLUSION: </strong>Parents with low health literacy commonly reported difficulty with EI referrals including contact problems and confusion. Strategies that accommodate parents with low health literacy level may improve referral success.</p>