Children's Health is a pediatric health care system in North Texas anchored by two hospitals, Children's Medical Center Dallas and Children's Medical Center Plano, as well as seven specialty centers and 19 pediatric clinics located throughout the region. A private, not-for-profit organization, Children's Health provides pediatric health, wellness and acute care services for children from birth to age 21, including specialty care, primary care, home health, a pediatric research institute, and community outreach services.According to Beckers Hospital Review, Children's Health is the fifth largest pediatric healthcare provider in the nation. Children's Health is also a pediatric kidney, liver, heart, bowel, and bone marrow transplant center, and includes a designated Level 1 trauma center.Until 2014, Children's Health was known by the name of its main hospital, Children's Medical Center Dallas. In September 2014, it rebranded as Children's Health, legally known as Children's Health System of Texas.
INTRODUCTION:The childhood overweight and obesity (OW/OB) epidemic in the United States disproportionately affects children from marginalized backgrounds, particularly those who lack the financial resources or support to engage in evidence-based interventions. Moreover, healthcare systems struggle to deliver these interventions equitably. To address this gap, this study evaluated the implementation science outcomes of Dynamo Kids! (DK!), a novel primary-care-based eHealth intervention intended for families with children ages 6-12 with OW/OB. MATERIALS AND METHODS:DK! was developed within a major safety-net hospital system in Dallas, TX. Ten providers in three different clinics were instructed to offer DK! to 581 families with children ages 6-12 with OW/OB. Guided by the Reach, Effectiveness, Adoption, Implementation Maintenance (RE-AIM) framework, we evaluated the implementation science outcomes of the DK! pilot conducted between August 2020 and April 2021, using eight different data sources-both qualitative and quantitative. RESULTS:Building on previously published findings that demonstrated an increase in Family Nutrition Physical Activity score and a decrease in child%BMIp95, this study engaged 46 families and ten providers with diverse backgrounds in a safety-net practice who, generally, self-reported improved knowledge, skills, and self-efficacy in treating overweight and obesity. Most parents were satisfied with the DK! intervention, using the website with high variability, on average for two hours 24 minutes of total user time over three months and endorsed the patient-centered care in qualitative interviews. Both families and providers generally found DK! to be important, trustworthy, tailored, and accessible and endorsed the DK! intervention. DISCUSSION:DK! demonstrated limited success in its initial setting, with strong support for its continuation and expansion from both the healthcare system and patient families. Future studies should incorporate user recommendations and consider comparing outcomes to a control group beyond the context of the COVID-19 pandemic.
Background and objective Although the focus on sleep disturbances in children who have experienced adversity has increased, little is known about sleep among children in foster care (CFC). This study aimed to review what research tells us about the relationship between foster care experience and sleep disturbances and to identify knowledge gaps. Method This study used Arksey and O’Malley's (2005) 5-part methodology for conducting scoping reviews and the Reporting Checklist for Scoping Reviews (PRISMA-ScR) guidelines. 14 studies met inclusion criteria. Data were synthesized using the 6-phased approach to thematic analysis outlined by Braun and Clarke (2006, 2021). Results The majority of included studies were conducted in the United States, used cross-sectional designs, and collected data from foster caregivers. Three themes emerged: sleep quality and disorders; relationships among sleep, trauma, and behavior-related outcomes; and intervention approaches (behavioral, pharmacological, and digital). The most commonly mentioned sleep problems were waking during the night, difficulty falling asleep, night terrors, bed wetting, and sleep efficiency and/or quality. Several studies suggested that trauma exposure played a central role in sleep disturbances in CFC and that unresolved trauma and environmental instability contributed to ongoing fear and insecurity at bedtime and difficulty maintaining sleep.Only 2 studies evaluated intervention effectiveness. Conclusions This review suggests that sleep disturbances are a pervasive yet underrecognized issue among CFC. Overall, the literature underscores that sleep health in CFC is both a marker and a mechanism of broader emotional and physiological dysregulation.
Background Tracheostomy dependent patients are at risk for adverse events such as accidental decannulation, potentially causing serious harm, prolonging hospital stays, and increasing medical care costs. However, standardized tools for risk identification do not exist. Purpose This study aimed to develop and evaluate the Children’s Health Decannulation Risk Assessment Tool (CH-DRAT), a focused assessment instrument designed to reduce the risk of accidental decannulation in pediatric hospitalized patients. Methods Following instrument development, content validation and inter rater reliability assessment, a pilot study was conducted to assess the CH-DRAT’s psychometric properties. Predictive validity was examined using clinical outcomes, while sensitivity, specificity, and reliability were evaluated through statistical analysis of pilot data. Results The CHDRAT demonstrated predictive validity and strong sensitivity and specificity. During the study period there was a statistically significant 37% reduction in accidental decannulation rates compared to the year before. Conclusion Findings suggest that CHDRAT is a reliable and valid instrument for assessing accidental decannulation risk in pediatric patients, with potential to improve clinical decision-making and patient outcomes.
Background:Most health care transition (HCT) interventions target the outpatient setting. However, hospitalization may serve as an additional touchpoint to identify patients who require transition services. Local problem:At a large urban pediatric hospital, inpatient care coordinators (CC) complete an EMR-based general assessment that includes an optional HCT screening item. Baseline data showed low item completion. The project aimed to increase the proportion of eligible admissions among patients aged ≥ 16 years with documented completion of the HCT screening item by 50% from the pre-intervention baseline within 6 months. Methods:Using the Define, Measure, Analyze, Design, and Verify (DMADV) framework, monthly item completion among eligible admissions aged ≥ 16 years was tracked in a run chart. Training outcomes were assessed with anonymous before and after session surveys. Interventions:Stakeholders and process owners co-developed a standardized workflow that defined an age threshold for universal inpatient HCT screening (≥16 years) and delivered an interactive CC training session on HCT concepts and CC roles in HCT. Results:Documented completion increased from 44.0% in October 2024-74.4% in May 2025 (p = 0.004). In the training evaluation, after-session survey respondents reported higher self-reported confidence across survey items. Conclusion:Implementing standardized inpatient workflow and CC education was associated with improved documented completion of an EMR HCT screening item among eligible admissions for patients 16 years and older. The results support the feasibility of using hospitalization as an additional touchpoint to document HCT status. Future phases will focus on implementing structural EMR changes and developing referral pathways between inpatient and outpatient CC to support patients who need additional HCT support.
