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Background: Children with special health care needs including Down Syndrome, Autism Spectrum Disorder and Down Syndrome experience difficulties in receiving dental treatment. Silver Diamine Fluoride (SDF) and Silver Fluoride (SF) are a minimally invasive treatments options to arrest dental caries without sedation; local or general anaesthesia (GA). Aim: Evaluation of Brazilian's parents' acceptance of the use of SF in CSHCN. Methods: After receiving education on SF, 100 Parents of CSHCN completed a questionnaire concerning their acceptance of SF, in different dental situation. Result: Majority of parents (74,5%) agreed to the use of SF for their children. SF was more acceptable on posterior teeth (74,5%) when compared to its use on anterior teeth (43,1%). Parents accepted to use SF in order: to reduce infection and pain (82,4%); to avoid dental injection (72,5%) and treatment under GA (84,3%). The Majority of parents accepted the properties of SF (82,4%) and Silver (80,4%). Conclusion: Silver Fluoride was accepted as a treatment option for caries, by Brazilian parents of CSHCN. SF should be considered as a treatment option for caries limited to dentine for CSHCN, taking into consideration the individual needs and opinions with regard to aesthetics and exposure to fluoride and silver.

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INTRODUCTION: Special care dentistry (SCD) is still developing in XX. This study aimed to clarify whether primary care dentists are treating patients with special health care needs (SHCN), to know if they have had previous education on SCD (on an undergraduate or postgraduate level), whether their training level impacts their confidence when treating patients with SHCN, and to assess their opinion on SCD as a relevant topic in undergraduate education. METHODS: A survey was answered by 149 primary care dentists working for the National Health Service of the XX region in XX, including information on their daily clinical practice, undergraduate, and postgraduate training in SCD, and their opinions on them. RESULTS: Most interviewees would like to complement their training and believed that SCD should be formally incorporated into undergraduate programs. There was a significant association between confidence in treating patients with SHCN and the rating of their undergraduate training, and between confidence and the number of hours of continuous development courses. CONCLUSION: Most primary care dentists treat patients with SHCN regularly. Therefore, including training in the undergraduate curriculum and afterward becomes necessary to increase their confidence when facing this challenging group of patients.

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OBJECTIVE: To compare the characteristics and healthcare use of children with medical complexity who receive paid certified nursing assistant (CNA) care by a family member (family CNA) and by a traditional nonfamily member (nonfamily CNA). STUDY DESIGN: This was retrospective cohort study of children who received CNA care through Colorado's Medicaid paid family caregiving program between 2017 and 2019 by a home healthcare agency. We compared patient characteristics between the family CNA and nonfamily CNA groups. A multivariable Poisson regression model was used to compare hospitalization rates (days in the hospital per year), adjusting for patient age patient sex, nursing care, and complex chronic condition. RESULTS: Of 861 patients, 79% (n = 680) received family CNA care and 21% (n = 181) received nonfamily CNA care. Patient demographics and hospitalization did not differ between the groups, although patients who had family CNAs were less likely to receive additional nursing-level care (42% vs 60%, P < .01). Family and nonfamily CNA caregivers had similar characteristics, except that family CNA caregivers had substantially better 3-year retention (82% vs 9%, P < .01) despite lower average hourly pay ($14.60 vs $17.60 per hour, P < .01). Hospitalizations were rare (<10% of patients). In the adjusted model, patients who received family CNA care experienced 1 more hospitalized day per year, compared with patients who received nonfamily CNA care (P < .001). CONCLUSIONS: Paid family caregivers provided CAN-level care to children with medical complexity with a greater employee retention compared with nonfamily CNA caregivers, with marginally different hospitalization rates using a family-centered approach. This model may help address workforce shortages while also providing income to family caregivers.

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Formar enfermeiros capazes de responder às demandas da sociedade exige um ensino contextualizado e consistente que os prepare para enfrentar os desafios do dinamismo do mundo moderno e das condições de exercício profissional. A acelerada modernização científica e tecnológica tem garantido maior sobrevivência a muitas crianças, ao passo que faz emergir uma clientela portadora de condições que requerem transformações de vida importantes: as Crianças com Necessidades Especiais de Saúde (CRIANES). Frente ao atual perfil epidemiológico infantil, delineou-se como objeto do estudo: o desenvolvimento de competências no processo de formação do enfermeiro na atenção integral às CRIANES e suas famílias. Definiu-se como objetivo geral: analisar como se organiza o ensino da atenção à saúde da criança nos cursos de graduação em enfermagem com vistas ao desenvolvimento de competências para o cuidado às CRIANES e suas famílias, na perspectiva dos docentes; e específicos: apreender a concepção dos docentes dos cursos de graduação em enfermagem sobre as CRIANES; identificar os conteúdos programáticos e os aspectos metodológicos do ensino referentes à atenção à saúde das CRIANES e suas famílias nos cursos de graduação em enfermagem; descrever, na perspectiva dos docentes, como acontece o ensino da saúde da criança de forma a desenvolver nos alunos as competências necessárias para o cuidado às CRIANES e suas famílias. Pesquisa qualitativa, descritivo-exploratória, com 17 docentes da área de saúde da criança de cursos de graduação em enfermagem de três Instituições de Ensino Superior (IES) públicas federais, na região metropolitana do estado do Rio de Janeiro. Aprovada pelo Comitê de Ética em Pesquisa da instituição proponente e das instituições coparticipantes. A coleta de dados foi realizada através de entrevista semiestruturada. Através da análise de conteúdo temático-categorial de Bardin, construíram-se quatro categorias, interpretadas e discutidas à luz do referencial teórico de Philippe Perrenoud: 1) As CRIANES e suas famílias na perspectiva docente; 2) A abordagem da temática das CRIANES nos cursos de graduação em enfermagem; 3) Estratégias de ensino e o processo de avaliação na abordagem das CRIANES nos cursos de graduação em enfermagem: desenvolvimento de competências; 4) Aspectos valorizados no desenvolvimento da competência de atenção à saúde das CRIANES e suas famílias na formação de enfermeiros. Evidenciou-se um processo de incorporação da temática nos cursos de graduação em enfermagem, reflexo da apropriação do conceito de CRIANES pelos próprios docentes. Tema ainda pouco explorado em seus aspectos particulares, com uma abordagem assistemática e pontual sob a ótica do modelo biomédico e hospitalocêntrico. Entretanto, valorizou-se a abordagem centrada na família e a articulação das redes de atenção à saúde, traduzindo a busca pela atenção integral. Os resultados reforçam o desafio e a importância de incluir a temática nos programas curriculares e nas práticas pedagógicas para ampliar as discussões na graduação de enfermagem. Trouxe subsídios para embasar e auxiliar o planejamento do ensino com relação à problemática das CRIANES e suas famílias, para formar enfermeiros que sejam atores sociais no cenário da saúde da criança no país.

Training nurses capable of responding to the demands of society requires a contextualized and consistent training that prepares them to face the challenges of the dynamism of the modern world and the conditions of professional practice. The accelerated scientific and technological modernization has ensured greater survival for many children, while a clientele with conditions that require important life transformations has risen: Children with Special Health Care Needs (CSHCN). In view of the current epidemiological profile of children, the following object of study was outlined: the development of competences in the process of nursing education in integral care for CSHCN and their families. It was defined as general objective: to analyze how the teaching of child health care is organized in undergraduate nursing courses with a view to developing competencies for the care of children and their families from the professors' perspective; and the specific objetives were: to capture the conception of the professors of undergraduate nursing courses on CSHCN; to identify the program contents and methodological aspects of teaching related to the health care of CSHCN and their families in undergraduate nursing courses; to describe, from the professors' perspective, how child health teaching occurs in order to develop in students the necessary competences for the care of CSHCN and their families. Qualitative, descriptive and exploratory research with 17 professors of child health care from undergraduate nursing courses of three federal public higher education institutions (HEIs) in the metropolitan region of Rio de Janeiro state in Brazil. Approved by the Research Ethics Committee of the proposing institution and co-participating institutions. Data collection was conducted through semi-structured interview. Through the thematic-categorical content analysis of Bardin, four categories were constructed, interpreted and discussed in the light of the theoretical referential of Philippe Perrenoud: 1) CSHCN and their families in the professors' perspective; 2) The approach to the subject of CSHCN in undergraduate nursing courses; 3) Teaching strategies and the evaluation process in the approach to CSHCN in undergraduate nursing courses: competence development; 4) Valued aspects in the development of the competence of attention to the health of CSHCN and their families in the training of nurses. A process of incorporation of this theme in the undergraduate nursing courses was evidenced, reflecting the appropriation of the concept of CSHCN by the professors themselves. This theme is still under explored in its particular aspects, showing an unsystematic and punctual approach from the perspective of the biomedical and hospital-centric model. However, the family-centered approach and the articulation of health care networks were valued, reflecting the search for integral care. The results reinforce the challenge and importance of including the theme in curricular programs and pedagogical practices to broaden discussions in undergraduate nursing. It brought important cobtributions to support and assist the education plannning related to the problem of CSHCN and their families, in order to train nurses who will become social actors in the child health scenario in the country.

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OBJECTIVE: To compare the rates of shared decision making (SDM) reported by parents of children with medical complexity (CMC) with the rates of SDM reported by parents of noncomplex children with special health care needs (CSHCN). STUDY DESIGN: We examined the 2009-2010 National Survey of Children with Special Health Care Needs, a representative survey of 40 242 parents of CSHCN. CMC was defined as needing or using more medical care than usual, seeing 2 or more subspecialists, and positive response on at least 3 other items on the CSHCN screener. We identified 3 subgroups each of CMC and noncomplex CSHCN by sentinel diagnoses: asthma, seizures, and other diagnoses. SDM was defined as a binary composite variable, derived from 4 discrete items. We constructed 4 stepwise multivariable models to assess the relative odds of SDM, adjusted for sociodemographic characteristics (age, income, language, race, ethnicity, and marital status), behavioral comorbidity, family-centered care, and patient-centered medical home. RESULTS: The study population included 39 876 respondents. Compared with noncomplex CSHCN, CMC had a lower likelihood of SDM (aOR, 0.76; 95% CI, 0.64-0.91), which persisted in diagnostic subgroups: CMC with asthma (aOR, 0.67; 95% CI, 0.49-0.92) and CMC with other diagnoses (aOR, 0.74; 95% CI, 0.58-0.94), but not CMC with seizures (aOR, 0.95; 95% CI, 0.59-1.51). CONCLUSIONS: SDM is less common for CSHCN with complex needs than those without complex needs. Health system interventions targeting future-oriented care planning may improve SDM for CMC.

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OBJECTIVE: To describe typical care experiences and key barriers and facilitators to caring for children with medical complexity (CMC) from the perspective of community primary care providers (PCPs). STUDY DESIGN: PCPs participating in a randomized controlled trial of a care-coordination intervention for CMC were sent a 1-time cross-sectional survey that asked PCPs to (1) describe their experiences with caring for CMC; (2) identify key barriers affecting their ability to care for CMC; and (3) prioritize facilitators enhancing their ability to provide care coordination for CMC. PCP and practice demographics also were collected. RESULTS: One hundred thirteen of 155 PCPs sent the survey responded fully (completion rate = 73%). PCPs endorsed that medical characteristics such as polypharmacy (88%), multiorgan system involvement (84%), and rare/unfamiliar diagnoses (83%) negatively affected care. Caregivers with high needs (88%), limited time with patients and caregivers (81%), and having a large number of specialists involved in care (79%) were also frequently cited. Most commonly endorsed strategies to improve care coordination included more time with patients/caregivers (84%), summative action plans (83%), and facilitated communication (eg, e-mail, phone meetings) with specialists (83%). CONCLUSIONS: Community PCPs prioritized more time with patients and their families, better communication with specialists, and summative action plans to improve care coordination for this vulnerable population. Although this study evaluated perceptions rather than actual performance, it provides insights to improve understanding of which barriers and facilitators ideally might be targeted first for care delivery redesign.

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Improvements in staff training, identification, and treatment planning for children with special health care needs who have behavioral issues are routinely recommended, but a literature review revealed no coherent plans targeted specifically toward pediatric ED staff. METHODS: An educational module was delivered to emergency staff along with a survey before and after and 1 month after the intervention to examine comfort in working with children with behavioral special needs and the ability to deliver specialized care. Child life consultations in the pediatric emergency department were measured 3 months before and 3 months after the education was provided. RESULTS: A total of 122 staff participated and reported clinically significant improvements across all areas of care that were maintained at 1 month. IMPLICATIONS FOR PRACTICE: To the best of our knowledge, this project represents the first quality improvement project offering behavioral needs education to emergency staff at a large pediatric hospital with an examination of its impact on staff competence, comfort, and outcomes. A large-scale educational module is a practical option for improvement in pediatric ED staff competence in caring for patients with behavioral special needs.

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OBJECTIVES: To measure the prevalence of enhanced access services in pediatric primary care and to assess whether enhanced access services are associated with lower emergency department (ED) utilization. STUDY DESIGN: Internet-based survey of a national sample of parents (n = 820, response rate 41%). We estimated the prevalence of reported enhanced access services and ED use in the prior 12 months. We then used multivariable negative binomial regression to assess associations between enhanced access services and ED use. RESULTS: The majority of parents reported access to advice by telephone during office hours (80%), same-day sick visits (79%), and advice by telephone outside office hours (54%). Less than one-half of parents reported access to their child's primary care office on weekends (47%), after 5:00 p.m. on any night (23%), or by email (13%). Substantial proportions of parents reported that they did not know if these services were available (7%-56%, depending on service). Office hours after 5:00 p.m. on ≥ 5 nights a week was the only service significantly associated with ED utilization in multivariable analysis (adjusted incidence rate ratio: 0.51 [95% CI 0.28-0.92]). CONCLUSIONS: The majority of parents report enhanced access to their child's primary care office during office hours, but many parents do not have access or do not know if they have access outside of regular office hours. Extended office hours may be the most effective practice change to reduce ED use. Primary care practices should prioritize the most effective enhanced access services and communicate existing services to families.

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