OBJECTIVE:A Maternal and Child Health (MCH) workforce skilled in program evaluation is vital for program assessment and data-driven decision making. Collaborative evaluation capacity-building opportunities for state, tribal, local, and territorial (STLT) public health staff, partner organizations, and students are key strategies in building a skilled workforce, promoting program improvement, effectiveness, and sustainability to improve long-term MCH outcomes. We evaluated the Centers for Disease Control and Prevention and Harvard T.H. Chan School of Public Health Program Evaluation Practicum to determine if it contributed to STLT participants' ability to implement evaluation plans responsive to their MCH programs and gather recommendations for Practicum improvement. DESIGN:Qualitative one-on-one interviews; data collected July-August 2023. PARTICIPANTS:Eighteen STLT public health staff, including Centers for Disease Control and Prevention Maternal and Child Health Epidemiology Program (MCHEP) field assignees, who participated in the Practicum between 2018 and 2022. MAIN OUTCOME MEASURES:Experiences of STLT MCH program staff and Centers for Disease Control and Prevention MCHEP field assignees. RESULTS:Six facilitator themes and 6 barrier themes for evaluating MCH programs were identified. Facilitators: an appreciation for evaluation from program partners and recipients; data availability; resources to support evaluation tasks; funding; internal program evaluation capacity; and organizational support. Barriers: data or systems access issues; staff turnover; shifting priorities; lack of evaluation readiness; limited evaluation capacity; and data collection issues. Four lessons-learned themes were identified: need for improved data collection tools; identification of future training needs; facilitation of programmatic decisions; and facilitation of evaluation buy-in. Five themes for recommendations on improving the Practicum were identified: collaborative learning and real-world examples; more evaluation support; modifying the Practicum structure; establishing appropriate Practicum teams; and helping programs determine evaluation readiness. CONCLUSIONS:Collaborative evaluation training like the Practicum can strengthen evaluation capacity within MCH programs and support program improvement. However, the Practicum may benefit from updated guidance, content, and structure to better assess participants' evaluation readiness and meet participants' needs.

We evaluated the feasibility and acceptability of adding more detailed choices for race, ethnicity, sex, gender, and socio-economic status for a demographic survey used by families both within and outside a large learning health network, the Autism Care Network (ACNet). We updated our demographic survey using an iterative approach, incorporating qualitative and quantitative feedback from interested parties across the US and Canada. Pilot testing of the revised survey was conducted with families with and without autism served by two large academic pediatric tertiary care centers. Through purposive sampling, recruitment was enriched for families from ethnic, racial, or gender minority backgrounds. The updated demographic survey increased the number of response options for race and ethnicity, sex, gender, and language. 85 families within the ACNet and 242 families outside the ACNet provided feasibility and acceptability data. 41% of respondents were from nonWhite or multiple race groups. 99% of respondents rated the updated form same or better than the original. 91% of respondents rated the updated form as acceptable, while 97% rated the survey as feasible. Despite concerns about the burden on respondents, we found high rates of feasibility and acceptability of more granular response options in demographic surveys. Researchers can adapt this approach to make their own more granular demographic forms focused on the specific variables relevant to their study and local contexts. More granular demographic data can identify strengths and gaps in representation that could impact a study's generalizability.

IMPACT:Disability-related child maltreatment is not well defined or understood but should be part of systematic pediatric screening practices. Disability-related child maltreatment can be operationalized by these four domains: (1) Denial or manipulation of assistive technology; (2) Denial or undermining of care, assistance, or access; (3) Intentional worsening of disability-related function; (4) Engaging disability as a means to invoke harm. More research on disability-related maltreatment is needed to understand the unique and overlapping contributions these experiences may have in relation to other forms of child maltreatment.

The electronic health record (EHR) should contain information to support culturally responsive care and research; however, the widely used default “Asian” demographic variable in most US social systems (including EHRs) lacks information to describe the diverse experience within the Asian diaspora (e.g., ethnicities, languages). This has a downstream effect on research, identifying disparities, and addressing health equity. We were particularly interested in EHRs of autistic patients from the Asian diaspora, since the presence of a developmental diagnosis might call for culturally responsive care around understanding causes, treatments, and services to support good outcomes. The aim of this study is to determine the degree to which information about Asian ethnicity, languages, and culture is documented and accessible in the EHR, and whether it is differentially available for patients with or without autism. Using electronic and manual medical chart review, all autistic and “Asian” children (group 1; n = 52) were compared to a randomly selected comparison sample of non-autistic and “Asian” children (group 2; n = 50). Across both groups, manual chart review identified more specific approximations of racial/ethnic backgrounds in 54.5

Disparities in healthcare access, delivery, and outcomes exist between autistic and non-autistic individuals. Autism-friendly healthcare initiatives aim to facilitate and improve the healthcare experience of autistic individuals by addressing commonly encountered challenges. While there is no consensus regarding the definition of autism-friendly healthcare, in this narrative review, we examine previously published research to determine the most important components of autism-friendly healthcare. Patient-related factors, provider-related factors, and system-related factors should be addressed. Proactivity, flexibility, and collaboration should guide the process of transforming the healthcare system. Finally, multiple strategies can be utilized as appropriate to the setting and individuals.

BACKGROUND:Postpartum depression (PPD) occurs after delivery, with severity and onset varying by individual. Women with low social support may be at higher risk for PPD. This study examined the association between social support and self-reported postpartum depression symptoms (PDS) among Illinois postpartum women. METHODS:Using 2016-2020 data from the Illinois Pregnancy Risk Assessment Monitoring System (PRAMS) (n = 5886), instrumental support (physical, hands-on support) and partner emotional support were each categorized as high/low and were combined in a composite measure (high = high on both types, moderate = high on one type, and low = low on both types). PDS were self-reported. Crude and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using logistic regression. RESULTS:Overall, 9.6% (95% CI = 8.8-10.4) of Illinois postpartum women experienced PDS. Of Illinois postpartum women, 63.5% (95% CI = 62.1-64.9) had high composite support, 29.3% (95% CI = 28.0-30.6) had moderate composite support, and 7.1% (95% CI = 6.4-7.9) had low composite support. After adjustment for maternal characteristics, instrumental support, partner emotional support, and a composite measure of support were each significantly associated with PDS. Compared to women with high composite support, women with low composite support had six times the odds of PDS (aOR = 6.1, 95% CI = 4.5-8.2), and women with moderate composite support had nearly three times the odds of PDS (aOR = 2.7, 95% CI = 2.2-3.4). CONCLUSION:PDS was associated with instrumental support, partner emotional support, and a composite measure of support in Illinois postpartum women. This suggests the importance of addressing social support for postpartum individuals.

Sleep problems are common in children with autism spectrum disorder (ASD), with 40% to 80% prevalence. Common disorders include insomnia, parasomnias, and circadian rhythm sleep-wake disorders. These problems have a multifactorial etiology and can both exacerbate and be exacerbated by core ASD symptoms. Sleep problems also impact the health and quality of life of both patients and their caregivers. All children with autism should be regularly screened for sleep problems and evaluated for co-occurring medical contributors. Behavioral interventions with caregiver training remain first-line treatment for sleep disorders in both neurotypical and neurodiverse youth.

BackgroundExperiencing foster care is associated with a range of negative outcomes in adulthood and identifying protective factors that can be leveraged by intervention efforts is crucial. Social support is one such factor that may have a positive benefit for this population. As such, this review aims to examine the breadth and quality of intervention studies which may be used to enhance social support for youth in foster care, as well as the types of support networks (e.g., family members) directly leveraged within interventions to promote social support.MethodsA systematic literature search was conducted across five databases (PubMed, PsycINFO, Cochrane database, Scopus, and Web of Science). Included studies were written in English, present an original peer reviewed study on an intervention which may be used to enhance social support for youth in foster care, feature an experimental design, take place in the United States, include an examination of youth-specific social support, and include study participants school-aged and older. The quality of studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines.ResultsTen articles were included in the present review. The interventions discussed in the review included family finding and engagement efforts, skills training and mentoring programs, and a peer support group. Interventions varied in networks leveraged to promote social support; five involved family members and non-related adults, two used family members only, two included non-related adults only, and one involved peers. Studies also varied considerably in methodology used to assess social support. Six articles, representing four interventions, found evidence for interventions to positively impact youth social support.ConclusionsEvidence from the present review suggest that few experimental studies have been conducted on interventions to promote social support, and the included studies indicate that interventions vary considerably in program components, networks involved, and methodology used to assess social support. Though the literature is too limited to draw overarching conclusions and suggest promising models for future interventions, the findings highlight important gaps in the existing literature and provide useful guidance for future work. Future research should give careful attention to the networks utilized and methodology used to assess social support.

Within a multi-state Collaborative Improvement and Innovation Network addressing the social determinants of health during 2017–2020, the Illinois Department of Public Health led an exploratory project to understand how the availability of child care affects maternal health care utilization. The project assessed whether lack of child care was a barrier to perinatal health care utilization and gathered information on health facility practices, resources, and policies related to child care TWe surveyed (1) birthing hospitals (n = 98), (2) federally qualified health centers (FQHCs) (n = 40), and (3) a convenience sample of postpartum persons (n = 60). Each group reported that child care concerns negatively affect health care utilization (66

Background: Social support is commonly examined as a protective factor for children with a history of child maltreatment, and it has been measured by self-report via the Social Support Scale for Children (SSSC). Although the SSSC has established adequate reliability and validity in community and clinical samples, its psychometric properties have yet to be assessed in a sample of foster care youth. Objective: This study provided a psychometric comparison of the SSSC in youth residing in foster care with youth residing in the community. Participants and setting: Participants were two, comparable samples of 214 youth participants residing in foster care and 163 youth participants from the community between the ages of 8-12 years. Methods: Community participants were recruited from local middle schools, and an age-matched comparison sample from a larger study on youth in foster care was utilized for comparison. Youth self-reported across measures and provided demographic information. Confirmatory factor analysis was utilized to determine measurement model fit to the data, and invariance testing was conducted to compare measurement models across the samples. Results: Differences between samples in the factor structure and item distribution of the SSSC emerged. Specifically, the community sample provided adequate fit to the original four-factor model (friend, classmate, teacher, parent) of the SSSC, whereas the foster sample required a three-factor model (combined friend and classmate constructs). The newly defined three-factor model provided significant associations with youth behavioral and emotional outcomes. Conclusions: Youth in foster care may perceive social support across sources differently from youth residing in the community.

Children with autism spectrum disorder (ASD) report high rates of sleep problems. In 2012, the Autism Treatment Network/ Autism Intervention Research Network on Physical Health (ATN/AIR-P) Sleep Committee developed a pathway to address these concerns. Since its publication, ATN/AIR-P clinicians and parents have identified night wakings as a refractory problem unaddressed by the pathway. We reviewed the existing literature and identified 76 scholarly articles that provided data on night waking in children with ASD. Based on the available literature, we propose an updated practice pathway to identify and treat night wakings in children with ASD.

OBJECTIVE: Part C Early Intervention (EI) services have been shown to reduce autism symptoms and promote healthy de-velopment among young children. However, EI participation remains low, particularly among children from structurally marginalized communities. We investigated whether family navigation (FN) improved EI initiation following positive primary care screening for autism compared to conventional care management (CCM).METHODS: We conducted a randomized clinical trial among 339 families of children (ages 15-27 months) who screened as having an increased likelihood for autism at 11 urban primary care sites in 3 cities. Families were randomized to FN or CCM. Families in the FN arm received community-based outreach from a navigator trained to support families to overcome structural barriers to autism evaluation and services. EI service records were obtained from state or local agencies. The pri-mary outcome of this study, EI service participation, was measured as the number of days from randomization to the first EI appointment.RESULTS: EI service records were available for 271 children; 156 (57.6%) children were not engaged with EI at study en-rollment. Children were followed for 100 days after diagnostic ascertainment or until age 3, when Part C EI eligibility ends; 65 (89%, 21 censored) children in the FN arm and 50 (79%, 13 censored) children in the CCM arm were newly engaged in EI. In Cox proportional hazards regression, families receiving FN were approximately 54% more likely to engage EI than those receiving CCM (1.54 (95% confidence interval: 1.09-2.19), P = .02).CONCLUSIONS: FN improved the likelihood of EI participa-tion among urban families from marginalized communities.

Objective: Prior research on child maltreatment has focused on distinct features of maltreatment (type, severity, chronicity) important for youth outcomes, yet perpetrators of child maltreatment reported by youth have gone largely unstudied. The present study examines connections between perpetrators, the total number and type of perpetrators reported, and the frequency at which each type of perpetrator was reported across 24 relationship types to provide a foundation for future research seeking to provide comprehensive measurement of perpetrator profiles. Methods: Data from 503 youth in foster care (8-21 years old) were collected through the Studying Pathways to Adjustment and Resilience in Kids (SPARK) Project. Youth reported on their history of physical, sexual, and psychological maltreatment. Social Network Analysis (SNA) was used to visualize links between perpetrators within maltreatment type and paired samples t-tests were used to compare differences between network edge weights. Results: Full sample SNA results were highly interconnected and variable across maltreatment types. Biological parents and peers were the most common perpetrators of physical and psychological abuse with peers and non-family adults being most common for sexual abuse. Family and community member groupings were most distinct in the physical and psychological abuse networks whereas in the sexual abuse network, ties between perpetrators were more equidistant. Conclusions: Differences exist in perpetrator profiles across maltreatment types, adding a layer of complexity to how maltreatment experiences are captured, and variability in profiles might provide insight to differing youth outcomes. Understanding individual youth perpetrator profiles could be used to inform foster care placements and reduce the risk of revictimization.

Maltreatment type, severity, and chronicity are predictors of poor youth outcomes, yet youth reported perpetrators of abuse have gone largely unstudied. Little is known about variation in perpetration across youth characteristics (e.g., age, gender, placement type) and abuse features. This study aims to describe youth reported perpetrators of victimization within a foster care sample. 503 youth in foster care (ages 8–21 years) reported on experiences of physical, sexual, and psychological abuse. Follow up questions assessed abuse frequency and perpetrators. Mann-Whitney U Tests were used to compare central tendency differences in number of perpetrators reported across youth characteristics and victimization features. Biological caregivers were commonly endorsed perpetrators of physical and psychological abuse, though youth also reported high levels of peer victimization. For sexual abuse, non-related adults were commonly reported perpetrators, however, youth reported higher levels of victimization from peers. Older youth and youth residing in residential care reported higher numbers of perpetrators; girls reported more perpetrators of psychological and sexual abuse as compared to boys. Abuse severity, chronicity, and number of perpetrators were positively associated, and number of perpetrators differed across abuse severity levels. Perpetrator count and type may be important features of victimization experiences, particularly for youth in foster care.

The association between adverse childhood experiences (ACEs) and negative outcomes across physical, mental, and behavioral domains is well established. Health and human service settings offer unique contexts where problem identification/diagnostic processes and treatment efficacy would benefit from identification of ACEs early on in service delivery. Further, effective ACEs assessment within these settings provides a foundational gateway for needed referrals and intervention related to ACEs exposure. Barriers exist in ACEs assessment in health and human services settings, including provider training and knowledge, access to appropriate screening and referral sources, time burden, accuracy of ACEs reporting, and negative impacts of the screening process. This chapter describes why ACEs screening is important and beneficial, what the core components of ACEs screening may entail, who may be utilized for ACEs reporting, when ACEs should be assessed, and what methods should be used for effective ACEs assessment. Recommendations for effective ACEs assessment include: (1) developmental tailoring of assessment methods and questions; (2) triangulation of reporting sources of ACEs exposures; (3) universal screening and repeated evaluation of ACEs across time; (4) guidelines and training for ACEs assessment procedures, including what key features of ACEs should be evaluated on follow-up of a positive screen; and (5) interdisciplinary approaches to ACEs assessment and response to promote positive assessment experiences and support access to resources in the case of positive screens.

OBJECTIVES:The Illinois Department of Public Health (IDPH) assessed whether increases in the SARS-CoV-2 test positivity rate among pregnant people at labor and delivery (L&D) could signal increases in SARS-CoV-2 prevalence in the general Illinois population earlier than current state metrics. MATERIALS AND METHODS:Twenty-six birthing hospitals universally testing for SARS-CoV-2 at L&D voluntarily submitted data from June 21, 2020 through January 23, 2021, to IDPH. Hospitals reported the daily number of people who delivered, SARS-CoV-2 tests, and test results as well as symptom status. We compared the test positivity rate at L&D with the test positivity rate of the general population and the number of hospital admissions for COVID-19-like illness by quantifying correlations in trends and identifying a lead time. RESULTS:Of 26 633 reported pregnant people who delivered, 96.8% (n = 25 772) were tested for SARS-CoV-2. The overall test positivity rate was 2.4% (n = 615); 77.7% (n = 478) were asymptomatic. In Chicago, the only region with a sufficient sample size for analysis, the test positivity rate at L&D (peak of 5% on December 7, 2020) was lower and more stable than the test positivity rate of the general population (peak of 14% on November 13, 2020) and lagged hospital admissions for COVID-19-like illness (peak of 118 on November 15, 2020) and the test positivity rate of the general population by about 10 days (Pearson correlation = 0.73 and 0.75, respectively). PRACTICE IMPLICATIONS:Trends in the test positivity rate at L&D did not provide an earlier signal of increases in Illinois's SARS-CoV-2 prevalence than current state metrics did. Nonetheless, the role of universal testing protocols in identifying asymptomatic infection is important for clinical decision making and patient education about infection prevention and control.

ABSTRACT: Objective: The objective of this study was to investigate the presence of maternal autoantibody–related autism spectrum disorder (MAR-ASD) in 2 geographically distinct DBPNet clinical sites (Pennsylvania and Arkansas). MAR-ASD is a biologically defined subtype of ASD that is defined by the presence of autoantibodies specific to proteins in the fetal brain and present in approximately 20% of a Northern California sample but has not been studied in other states. Methods: Sixty-eight mothers of children with ASD were recruited from 2 DBPNet clinics and provided blood samples. Mothers also completed behavioral questionnaires about their children, and data from the child's clinical diagnostic assessment were abstracted. Results: The mean age of mothers was 38.5 ± 6.1 years, and the mean age of children was 8.3 ± 2.7 years. MAR-ASD was present in 24% of the sample and similar across sites. Children of +MAR mothers had more severe autism symptoms as measured by Autism Diagnostic Observation Schedule comparison scores (W = 3604; p < 0.001) and the Social Communication Questionnaire (W = 4556; p < 0.001). There were no differences in IQ, adaptive function, or aberrant behavior. Conclusion: MAR-ASD is a subtype of autism that is present in similar frequencies across 3 states and related to autism severity.