First name
Carina
Last name
Flaherty

Title

A Health System-Initiated Intervention to Remediate Homes of Children With Asthma.

Year of Publication

2023

Number of Pages

Date Published

05/2023

ISSN Number

1098-4275

DOI

10.1542/peds.2022-058351

Alternate Title

Pediatrics

PMID

37042200
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Featured Publication
No
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Title

Asthma medication adherence during the coronavirus disease 2019 pandemic in children at high risk of exacerbation.

Year of Publication

2023

Number of Pages

Date Published

04/2023

ISSN Number

1534-4436

DOI

10.1016/j.anai.2023.04.007

Alternate Title

Ann Allergy Asthma Immunol

PMID

37080458
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Featured Publication
No
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Title

Innovations in Evidence-Based Home Visiting Intended to Engage and Support Families Impacted by Opioid Use Disorder: Three Case Studies from Pennsylvania Pilot Programs.

Year of Publication

2023

Number of Pages

218-225

Date Published

02/2023

ISSN Number

1573-6628

Abstract

BACKGROUND: Pregnancy and early parenthood can be challenging transitional times for many families, especially those struggling with opioid use disorder (OUD). Over 8 million children live with a parent with SUD and parental drug use has been attributed to rising rates of family instability and child welfare involvement (Lipari & Van Horn, 2017; AFCARS, 2020;). Community-based prevention programming for families with young children, such as evidence-based maternal and child home visiting (EBHV), may we well positioned to engage and support families impacted by the opioid epidemic through early childhood. This paper presents case studies to highlight promising practices for adapting EBHV models to families impacted by SUD from the perspectives of staff and administrators.

METHODS: Data from three pilot sites are presented as case studies. These sites were selected to represent the most innovative and developed adaptations to EBHV for families impacted by substance use from an implementation evaluation of state-funded pilot sites (N = 20) at existing home visiting agencies across Pennsylvania. Data reported here represent semi-structured interviews with 11 individuals. Data were coded to facilitators and barriers nodes to understand the process and impact of pilot implementation.

RESULTS: Systems-level collaboration and coordination were key to serving a population already engaged in multiple systems. Engagement of substance use experts allowed home visitors to focus on delivery of evidence-based curricula supporting family stability and child development. External partnerships reduced stigma among home visitors. Across sites, staff struggled with the increased acuity of social complexity of the OUD population.

CONCLUSIONS FOR PRACTICE: Pregnancy and early parenthood are challenging transitional times for many families, especially those with OUD. Evaluation results demonstrate the promise of systems-based adaptations to community-based prevention programming for families with young children, such as maternal and child home visiting, to better support families impacted by SUD.

DOI

10.1007/s10995-023-03586-8

Alternate Title

Matern Child Health J

PMID

36670308
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No
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Title

Promoting healthy childhood behaviors with financial incentives: A narrative review of key considerations and design features for future research.

Year of Publication

2021

Number of Pages

Date Published

2021 Aug 14

ISSN Number

1876-2867

Abstract

<p>In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose five general considerations in designing and applying incentive interventions to children. These include: (1) the potential impact of incentives on intrinsic motivation, (2) ethical concerns about incentives promoting undue influence, (3) the importance of child neurodevelopmental stage, (4) how incentives interventions may influence health disparities, and (5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss versus gain), timing (immediate versus delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation.</p>

DOI

10.1016/j.acap.2021.08.010

Alternate Title

Acad Pediatr

PMID

34403802
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Title

The Tailored Adherence Incentives for Childhood Asthma Medications Randomized Trial: A Research Protocol for Children with High-Risk Asthma.

Year of Publication

2020

Number of Pages

Date Published

2020 Apr 07

ISSN Number

1929-0748

Abstract

<p><strong>BACKGROUND: </strong>Poor adherence to inhaled corticosteroid (ICS) medications for children with high-risk asthma is a well-documented and poorly understood problem with a disproportionate prevalence and impact on urban minority children. Financial incentives have been shown as a compelling method to engage a high-risk asthma population, but whether and how adherence can be maintained and lead to sustained high adherence trajectories is unknown.</p>

<p><strong>OBJECTIVE: </strong>To determine the marginal effects of a financial incentive-based ICS adherence intervention on adherence, healthcare system use, and costs in a prospective cohort of child-caregiver dyads.</p>

<p><strong>METHODS: </strong>Participants include 125 children aged 5-12 years who have had at least two hospitalizations or one hospitalization and one emergency room visit for asthma in the prior year and their caregivers. All participants have an electronic inhaler sensor that is linked to a smartphone app to track medication use for 7 months. After one month of observation, participants are randomized to one of three possible arms for a 3-month experiment. Participants in arm 1 receive daily text message reminders, feedback, and nominal gain-framed financial incentives; those in arm 2 receive daily text message reminders and feedback only and those in arm 3 receive no reminders, feedback, or incentives. All participants are then observed for an additional 3 months with no reminders, feedback, or incentives to assess for sustained effects.</p>

<p><strong>RESULTS: </strong>Study enrollment began in September 2019. Estimated primary completion date is June of 2022 and analyses will be completed by June of 2023.</p>

<p><strong>CONCLUSIONS: </strong>The present study will provide data on whether a financial incentive-based mobile-health intervention for promoting ICS use is efficacious in high-risk asthma patients over time.</p>

<p><strong>CLINICALTRIAL: </strong>Clinicaltrial.gov NCT03907410; https://clinicaltrials.gov/ct2/show/NCT03907410.</p&gt;

DOI

10.2196/16711

Alternate Title

JMIR Res Protoc

PMID

32459653
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