It is well known that the lack of care coordination in the healthcare system causes numerous problems including cost inefficiency and inconsistent care, specifically for complex pediatric and adult patients. Many pediatric patients have complex medical and social service needs which can be expensive for both the patient’s parents and the general healthcare system. Therefore, it is difficult for the healthcare system to deliver the highest quality care possible, due to the number of appointments that have to be scheduled (with some being out of state), the large volume of physical health records, and overall lack of time parents have to coordinate this care while also caring for themselves and other family members. It is integral to find a more efficient way to coordinate care for these patients, in order to improve overall care, cost efficiency, and outcomes. <br/>A number of stakeholders in Arizona came together to work on this problem over several years. They were funded through a PCORI Eugene Washington Engagement grant to investigators at ASU. This project, Take Action for Arizona's Children through Care Coordination: A Bridge to Action was developed in order to further develop a research agenda and build the network (PCOR). Regional conferences were conducted in Flagstaff, Yuma, Phoenix, and Tucson, as well as a final capstone conference held in Phoenix. At these conferences, frustrations, suggestions, and opinions regarding Children with Special Health Care Needs (CSHCN) and navigating the healthcare system were shared and testimonials were transcribed.<br/>This study focused on the capstone conference. The study design was a strategic design workshop; results of the design analysis were analyzed qualitatively using descriptive content analysis. Themes described parent’s common experiences navigating the system, impacts resulting from such experiences, and desires for the care coordination system. Quotes were then grouped into major themes and subthemes for the capstone conference. After these themes were determined, the overarching goals of stakeholders could be assessed, and implementation projects could be described.

Children with congenital heart disease (CHD) are at increased risk for psychosocial issues (PSI), decreased quality of life (QOL), and decreased resilience. The purpose of this project was to implement a screening protocol for PSI, QOL, and resilience, with appropriate psychosocial referral for children with CHD.

A pilot protocol was implemented to screen children with CHD, aged 8-17 years, and parents, for resilience, QOL, and PSI. Referrals for psychosocial services were made for 84.2% of children screened (n = 16) based on scoring outcomes. Statistically significant differences in the parents and children’s resilience mean scores were noted. Higher parental scores may indicate that parents believe their children are more resilient than the children perceive themselves to be.
Early identification of concerns regarding QOL, resilience, and PSI in children with CHD can provide ongoing surveillance, while affording opportunities for improved communication between providers, parents, and children. Routine screening and longitudinal follow-up is recommended.

Diabetes mellitus (DM) is a detrimental disease that afflicts approximately 23.6 million Americans and costs $176 billion dollars annually in direct medical expenses (American Diabetes Association [ADA], 2015). Approximately 208,000 children and adolescents with diabetes are under the age of 20 years (ADA, 105; CDC, 2014). Currently, the standard of medical practice in school-aged children and adolescents with type 1 diabetes is to administer insulin after the child or teen has eaten. The most current evidence has demonstrated a decrease hemoglobin A1C (HbA1c) and preference for pre-prandial insulin administration (Cobry et al., 2010; Danne et al., 2003; DePalma et al., 2011; Enander et al., 2012; Luijf et al., 2010; Scaramuzza et al., 2010).

This Doctor of Nursing Practice (DNP) project delivered an educational program for parents of school age children and adolescents with type 1 diabetes and instituted pre-prandial insulin administration as the standard of care in an outpatient pediatric endocrine clinic. Education was delivered in both verbal and written formats. Data collection included weekly blood glucose reports and HbA1c at initial and follow-up sessions. Descriptive statistics were utilized to analyze the data. No post intervention data was able to be collected due to participant drop out. Future directions to promote this practice change are discussed.

Introduction: More than 1.2 million children in military families face long separations from a parent due to deployment or extended assignment, which can lead to significant family dysfunction as well as behavioral, emotional, and scholastic problems for the child. The purpose of From Caring 2 Coping is to identify and provide healthcare providers of military children tools to recognize and address maladaptive and externalizing behaviors of these children, while also assisting the nondeployed parent or caregiver to provide their children with the necessary support to reduce stress and increase their own coping skills.

Materials and Methods: After approval from Arizona State University IRB, children aged 4-11 years who are currently or forecasted to be separated from a military parent due to a deployment or extended assignment, were recruited from a military pediatric clinic along with their primary caregiver. An intervention was adapted from Bowen and Martin’s (2011) Resiliency Model of Role Performance for Service Members, Veterans, and their Families to identify and improve individual assets and family communication skills, find support through social connections, and prepare for potential stressors by constructing a Roadmap of Life. The Parental Stress Scale (PSS) and Pediatric Symptom Checklist (PSC-17) were completed before and after the 4-week intervention along with a final caregiver survey to evaluate the caregiver’s perceptions of From Caring 2 Coping.

Results: Four mothers and eight children completed the program for which Wilcoxon matched-pairs signed-rank test compared results from pre- and post PSC-17 surveys from the children showing significant improvement post-intervention (p = 0.017). The post PSC-17 results were compared to post PSS results with Spearman Correlation Coefficient, r = 0.949, that is statistically significant (p = 0.05). From Caring 2 Coping is rated as an effective program by parents in a postintervention survey that is easy to incorporate into daily activities. Parents ranked highest satisfaction through use of the Family Communication Plan and Family Timeline.

Conclusions: From Caring 2 Coping intervention tools improved family communication, use of individual assets and Roadmap of Life coping skills, thereby improving child and caregiver coping response as evidenced by improved PSC-17 and PSS scores. Basing the intervention on the Resiliency Model of Role Performance which has proven successful in the military population, improves the chances for success in this target population. However, the small sample size of four families requires further study with more families at all levels of the deployment cycle in order to refine the intervention.

There is an increased risk of misdiagnosis of Attention Deficit Hyperactivity Disorder (ADHD)
in preschoolers due to the lack of validated diagnostic tools and provider knowledge of normal behavior and development. The goal of this project was to standardize the diagnostic process by adopting an evidence-based ADHD algorithm protocol for preschoolers (3-5 years). In an urban military pediatric clinic, five pediatric care clinicians were provided with an educational ADHD algorithm.

Pre/posttest surveys were used to assess provider knowledge and perceptions of care. Chart audits determined preschooler ADHD diagnosis prevalence pre- and post-implementation of the algorithm. The rate of ADHD diagnosis in preschoolers reduced significantly from 78.6% pre-audit to 22.6% post-audit. In addition, providers improved their accuracy in diagnosing alternative disorders and behaviors that mimic the symptomology of ADHD (Z=-2.0, p=0.046). The rate of misdiagnosis of ADHD in preschoolers decreased because of the use of an evidence-based ADHD algorithm.

Aim: The purpose of this project was to determine if educating elementary school personnel would improve their knowledge and self-efficacy in caring for students with Cystic Fibrosis (CF) and improve the health and educational outcomes of students with this disease.

Background: Evidence suggests that teachers play a big role in the management of students with chronic illnesses. However, current literature indicates that teachers lack basic knowledge about childhood chronic illnesses and how to manage students with chronic illnesses. Synthesis of evidence indicated that an online CF educational intervention would improve knowledge and self-efficacy among school personnel, thereby improving the health and educational outcomes of students with CF.

Methods: Elementary school personnel in Southern Arizona were asked to do an online pre-survey to evaluate knowledge and self-efficacy, view a short presentation on cystic fibrosis, and complete a post-survey. Parents of students with CF were asked to track 504 plan use and CF related absences. Frequencies were used to evaluate participant demographic data and survey data. The McNemar and Wilcoxon Signed Test were used to analyze survey data.

Results: Analysis showed a statistically significant improvement in perceived knowledge (p = .024) and self-efficacy scores (p = .034). Although survey scores showed an average score improvement between pre-survey and post-survey total scores (p = .212), it was not statistically significant.

Conclusion: Results showed an overall improvement in CF knowledge and self-efficacy among elementary school personnel. These results may provide an opportunity for CF healthcare providers and schools to promote the health and education of students with CF.