Author: Nancy Fliesler

Learning disabilities: Kids and families struggle beyond the academics

Boy with learning disabilities struggles with homework

Most research on learning disabilities focuses on remediating specific academic skills like reading and math. But struggles at school and with homework can create an enormous amount of stress and anxiety for children and families, says neuropsychologist Deborah Waber, PhD, who directs the Learning Disabilities Program at Boston Children’s Hospital. …Read More

Managing anxiety in primary care pediatrics

managing anxiety in children

Anxiety is common in children and adolescents, but at what point does it cross the line and become a mental health concern? Notes posed this question to clinical psychologist Keneisha Sinclair-McBride, PhD, and child psychiatrist Olivia Carrick, MD, both in the Department of Psychiatry at Boston Children’s, and asked their management advice. …Read More

Quick Note: Improving nighttime communications in the hospital

hospital communications

It’s now well known that breakdowns in communications are a leading cause of hospital medical errors, contributing to more than 60 percent of serious adverse events. Efforts such as I-PASS, which standardize communications during patient “handoffs,” have cut harmful medical errors by 30 percent.

But nighttime care, which evidence suggests is particularly error-prone, has been somewhat overlooked. Researchers at Boston Children’s Hospital, led by Alisa Khan, MD, MPH and Christopher Landrigan, MD, MPH, also wanted to incorporate parents’ experience, which had been missing in nighttime communications when families were asleep. In this study in Academic Pediatrics, Khan, Landrigan and colleagues prospectively evaluated a family-centered, multidisciplinary nighttime communication intervention.

The intervention was developed with input from parents, nurses and medical residents, as well as the hospital’s Family Advisory Council, residency program and nursing leadership. It consisted of a short, early-evening nurse–physician briefing session at about 7:30 p.m.; a bedside, family-centered huddle in I-PASS format between 8 and 9 p.m.; and, for selected patients, a nightly family update sheet.

The team prospectively followed patients, parents and nighttime providers on two pediatric inpatient units at Boston Children’s. They surveyed parents and providers both pre-intervention (May-October 2013) and post-intervention (May-October 2014) and compared their answers.

The intervention wasn’t fully adopted by staff, but it did improve some aspects of communication. Providers’ experience improved in several domains. Parents reported more of a sense of shared understanding with nurses and a better experience communicating with nighttime doctors.

But several communication parameters did not improve, highlighting the importance of continued family involvement in research and design of the interventions. The ongoing multicenter Patient and Family Centered I-PASS Study is now testing several enhancements.

Valuing family-provided medical care for children with special health care needs

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About half of U.S. children with special health care needs — approximately 5.6 million — receive medical care from uncompensated family members. According to a recent study led by Boston Children’s Hospital and the University of Southern California (USC), the impact of in-home care is costing families billions. …Read More