Home visiting (HV) services promote child and family well-being, with most services targeting families at risk of experiencing health disparities. Yet, services remain underutilized by eligible populations. Moreover, those who do enroll in services often drop out before receiving the full dosage of home visits. The present study utilized the family engagement framework developed by the Cross-Model Collaboration and Data Sharing project (MODS) to examine internal constructs of engagement. Specifically, the primary study aim was to understand internal factors that may influence caregivers’ decision-making when offered evidenced-based home visiting services. Participants included 19 parents ages 21 through 43 years, all identifying as female. Semi-structured qualitative interviews were conducted on Zoom and then transcribed. Thematic analysis was conducted to draw out themes and subthemes using NVivo 14. Parents perceived the in-home service model and HV provision of support as appealing aspects of HV. Most parents were satisfied with their current areas of parenting but expressed interest in learning new parenting strategies. Parents needed more information about HV providers to aid their decision to enroll and simplified enrollment processes. Results suggest enhancing the enrollment process by providing more information about provider qualifications and minimizing administrative burdens, which in turn may increase family engagement with HV. HV promotes child and family well-being, with most services targeting families at risk of experiencing health disparities. However, enrollment among eligible families remains low. Research on HV engagement has focused on later stages of family engagement, such as participation and retention, with limited insight into a family’s decision to enroll. The study fills a critical gap in HV research by investigating the less studied internal states of family engagement, including perceptions, beliefs, and attitudes that may contribute to limited enrollment among eligible families. Results suggest eligible families desire relevant provision of services, easier enrollment processes, and disclosure of provider qualifications.

Objective Suicide has been a leading cause death in adolescents nationally for years; the full effect of COVID-19 pandemic and social isolation on pediatric mental health and subsequent suicidality is not yet fully understood. Method This retrospective chart review describes trends in patients 4 to 17 years of age who presented to the emergency room or for hospital admission with suicidal thoughts or acts of self-harm from January 2012 to July 2022. Both change point and auto-regressive moving average (ARMA) models were fit to patient presentation numbers; expected change in presentation rates in pandemic months were compared to pre-pandemic time periods. Results There was an increasing pattern of suicidal ideation and self-harm presentations throughout the entire study period, with an average baseline increase of 0.015 patient presentations per week. Change point and ARMA models both demonstrated an increase in patient presentations around April 2020; ARMA modeling estimated 1.67 additional patient presentations per week above pre-pandemic model predictions. Conclusion In the pandemic time period, there were significantly more patient presentations for suicidal ideation and intentional self-harm than would have been expected based on pre-pandemic patterns. This volume has continued up to 2 years after the pandemic declaration and has both mental health access and resource implications. Plain language summary This retrospective chart review describes trends in patients 4 to 17 years of age who presented to a tertiary children’s hospital with suicidal thoughts or acts of self-harm from January 2012 to July 2022. There was an increasing pattern of suicidal ideation and self-harm presentations throughout the entire study period with a sharp increase in presentations in April 2020 coinciding with the onset of the COVID-19 pandemic. This increase lasted throughout the study period and represented an additional 2 patient presentations per week than predicted by pre-pandemic modeling. Diversity & Inclusion Statement One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group.

BACKGROUND:Home visiting is an evidence-based service to reduce child abuse and neglect while providing parental information and resources. Despite strong empirical evidence for the benefits of home visiting, most eligible families do not enroll in services when offered and those who do enroll tend to drop out before completing the full dosage of visits. OBJECTIVE:To expand our understanding of enrollment and continued participation in home visiting programs from the perspective of providers. PARTICIPANTS AND SETTING:Providers (N = 19) from three federally funded home visiting programs in Oklahoma participated. METHODS:Qualitative interviews were developed using the Cross-Model Collaboration and Data Sharing (MODS) framework and focused on three aspects of internal states that have not been extensively considered: (1) perception of compatibility or fit, (2) readiness for change, and (3) confidence in ability to achieve outcomes. RESULTS:Home visiting programs were generally perceived to be highly compatible with parents' goals for their children, but other basic needs and priorities (e.g., work, food insecurity) may keep them from enrolling or continuing in services. Additionally, while parents are generally motivated to make changes that better support their child's development, they may be hesitant to discuss deeply personal topics (e.g., substance use, violence in the home). CONCLUSIONS:Findings highlight the importance of considering how families view their compatibility with home visiting, how ready they are to change, and how confident they are in their ability to achieve positive outcomes. Moreover, findings indicate strategies home visiting providers and programs can employ when interacting with families.

Developmental monitoring and promotion efforts are keys to identifying potential developmental concerns and connecting young children to intervention services. Evidence-based home visiting programs are one avenue for developmental monitoring and promotion, particularly for families with young children who may need extra support (e.g., families living in poverty, families dealing with substance use). In the present qualitative study, we interviewed parents (N = 23) and providers (N = 18) from three home visiting programs to understand the ways in which home visiting engages in developmental monitoring and promotion. Findings indicated that children participating in home visiting were regularly screened for developmental concerns (developmental monitoring). Providers also discussed screener results with parents and provided activities and materials to encourage parents to engage in positive parenting behaviors (developmental promotion). Barriers to monitoring and promotion were also uncovered and included family buy-in and logistical constraints. Implications suggest enhanced provider training to overcome barriers and greater policy and funding support for home visiting to extend the reach of home visiting and bolster developmental monitoring and promotion efforts.

Variable selection provides a pathway toward preventing generalized linear mixed models from encountering issues of model overfitting, nonconvergence, low external validity, and estimation biases. Among the various selection approaches, the methods of regularized penalized quasi-likelihood (rPQL) show some superiority in jointly choosing both important fixed and random effects. However, three challenges limit the wider usage of the variable selection approaches in practice: the high computational cost, the outnumbered predictors problem, and multicollinearity. To overcome these challenges, the current study proposes a new algorithm, the random rPQL, that incorporates an rPQL estimation with the resampling technique. In addition, the study introduces a new selection criterion, the ranking worth estimation, to the selection process. Simulation results indicate (a) random rPQL can select fixed and random effects with high accuracy and efficiency even when the number of candidate variables exceeds within-group observations or when severe multicollinearity exists. (b) The results also show that the ranking worth estimation is more robust in the progress of regularization integrated with the resampling approach. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

e23107 Background: Individuals with cancer often require hospitalization to address acute concerns. Structural barriers, such as socioeconomic deprivation, may impact patients’ healthcare utilization. However, little is known about associations of socioeconomic deprivation with clinical outcomes among hospitalized patients with cancer. Methods: We conducted a retrospective cohort study of adults with cancer who were admitted to the University of Oklahoma Medical Center from 1/2017-12/2022. We extracted information from the electronic health record about patients’ socioeconomic deprivation (measured as area deprivation index [ADI]), as well as demographic and clinical characteristics. We categorized ADI into quartile groups (Q1-Q4, with Q4 indicating areas of highest deprivation). We used regression models to explore associations of ADI with patients’ demographic/clinical characteristics and their clinical outcomes (hospital length of stay [hazard ratio {HR} for time to discharge], time to readmission, and overall survival). Results: Among 20,683 patients (mean age 62.2, 51.5% female sex, 41.0% metastatic disease), the most common cancer types were gastrointestinal (GI; 19.3%), genitourinary (13.8%), and gynecologic (13.7%). Races represented were White (80.1%), Black (9.8%), American Indian/Alaska Native (4.8%), Asian (2.6%), and other (2.7%). Mean ADI score was 56.9 ± 26.0, with 17.7% of patients in Q1, 17.6% in Q2, 36.5% in Q3, and 28.2% in Q4. Factors significantly associated with ADI included older age (Beta [B]=-.10, p<.001), race (American Indian/Alaska Native patients [B=11.5, p<.001] and Black patients [B=13.0, p<.001]), comorbid conditions (CCI 1-2 [B:1.47, p=.003]; CCI 3+ [B:2.41, p<.001]), and cancer type (GI: ref; CNS [B=-2.68, p<.001], melanoma [B=-3.85, p=.004], sarcoma [B=-4.19, p=.002]). In multivariable models adjusted for demographic variables significantly associated with ADI, higher ADI was associated with longer length of stay (Q1: ref, Q2: HR=.96, p=.067; Q3: HR .89, p<.001; Q4: HR=.88, p<.001), lower risk for readmission (Q1: ref, Q2: HR=.89, p=.002; Q3: HR=.87, p<.001; Q4: HR=.89, p<.001), and worse survival (Q1: ref, Q2: HR=1.08, p=.054; Q3: HR=1.17, p<.001; Q4: HR=1.20, p<.001). Conclusions: In this large cohort of hospitalized patients with cancer, we identified factors associated with socioeconomic deprivation, such as age, race, comorbid conditions, and cancer type. Importantly, we found patients residing in socioeconomically deprived areas experienced worse outcomes, including longer length of stay and worse overall survival (notably ADI was associated with lower risk of readmission, which is hypothesis-generating). Further understanding of structural barriers and how they correlate with outcomes of hospitalized patients with cancer is necessary to enhance care delivery and outcomes in socioeconomically vulnerable individuals.

Purpose: Cardiovascular risk factors (CVRFs) later in life potentiate risk for late cardiovascular disease (CVD) from cardiotoxic treatment among survivors. This study evaluated the association of baseline CVRFs and CVD in the early survivorship period. Methods: This analysis included patients ages 0-29 at initial diagnosis and reported in the institutional cancer registry between 2010 and 2017 (n = 1228). Patients who died within 5 years (n = 168), those not seen in the oncology clinic (n = 312), and those with CVD within one year of diagnosis (n = 17) were excluded. CVRFs (hypertension, diabetes, dyslipidemia, and obesity) within 1 year of initial diagnosis were constructed and extracted from the electronic health record based on discrete observations, ICD9/10 codes, and RxNorm codes for antihypertensives. Results: Among survivors (n = 731), 10 incident cases (1.4%) of CVD were observed between 1 and 5 years after the initial diagnosis. Public health insurance (p = 0.04) and late effects risk strata (p = 0.01) were positively associated with CVD. Among survivors with public insurance (n = 495), two additional cases of CVD were identified from claims data with an incidence of 2.4%. Survivors from rural areas had a 4.1 times greater risk of CVD compared with survivors from urban areas (95% CI: 1.1-15.3), despite adjustment for late effects risk strata. Conclusion: Clinically computable phenotypes for CVRFs among survivors through informatics methods were feasible. Although CVRFs were not associated with CVD in the early survivorship period, survivors from rural areas were more likely to develop CVD.

Parent-Child Interaction Therapy (PCIT) improves parenting practices in families at risk of abuse or neglect, yet parental verbalizations which influence child compliance remain understudied. This study examines how specific parenting verbalizations influence command-compliance interactions using a Clean-Up task from the Dyadic Parent-Child Interaction Coding System (DPICs) in a randomized control trial using at-risk families. Child compliance is improved with direct commands, positive verbalizations, and PCIT dosage, but frequent commands decrease it. Negative verbalizations have a moderated relationship: compliance probability increases with time elapsed since the last negative verbalization. Results uncover parental behaviors that increase compliance and how PCIT influences these.

Background: Both age-associated hearing loss (AAHL) and peripheral neuropathy (PN) are common in older patients, and both are associated with impaired balance, falls, and premature mortality. The objectives of this study were to document the prevalence and severity of AAHL in older primary care patients, and to explore associations between AAHL, PN, balance, falls, and mortality. Methods: We analyzed information obtained in 1999 from 793 primary care patients recruited from practices participating in the Oklahoma Longitudinal Assessment of the Health Outcomes of Mature Adults (OKLAHOMA) Studies. Available data included demographic and health information, history of falls and hospitalizations, audiometry, balance testing, examination of the peripheral nerves, 50 foot timed gait, and dates of death up to 22 calendar years and 8106 person-years of follow-up. Proportionate hazards (PH) and structural equation modeling (SEM) were used to examine associations between AAHL, PN, balance, gait time, and mortality. Results: 501 of the 793 participants (63%) had AAHL. Another 156 (20%) had low frequency and 32 (4%) had unilateral deficits. Those with moderate or severe AAHL and the 255 (32%) with PN had impaired balance (p < 0.0001), increased gait time (p = 0.0001), and reduced survival time (p < 0.0001). In the PH model, both AAHL and PN were associated with earlier mortality (H.Rs. [95% C.I.]: 1.36 [1.13-1.64] and 1.32 [1.10-1.59] respectively). The combination of moderate or severe AAHL and PN, present in 24% of participants, predicted earlier mortality than predicted by either deficit alone (O.R. [95% C.I.I] 1.55 [1.25-1.92]). In the SEM models, the impacts of both moderate or severe AAHL and PN on survival were mediated, in part, through loss of balance. Conclusions: Hearing loss and PN, both common in older patients, appear to be independently and additively associated with premature mortality. Those associations may be mediated in part by impaired balance. The Mechanisms are likely multiple and complex.

This study aims to enhance treatment completion prediction beyond the limitations of traditional logistic regression. Our approach utilizes a two-step machine learning method, integrating cross-validation and ensemble modeling to achieve this goal. First, we employ a feature selection process using random forest to identify the most pivotal variables for our prediction model. Various models are then created using common machine learning algorithms, and a stacking approach combines the set into an ensemble model. Model selection is guided by a comprehensive assessment of performance and practical considerations. Our predictive model not only prioritizes accuracy but also provides insights into the impact of individual attributes on treatment success. By forecasting success, solely using baseline characteristics, researchers can assess participants’ likelihood of completing treatment before it starts, aiding cost reduction, especially in resource-intensive programs, by selecting individuals who are more likely to complete treatment. Additionally, emphasis on relevant variables helps identify areas for improving adherence and commitment to the treatment regimen. Our approach’s validation involved a thorough assessment using a dataset comprising over 800 real child welfare cases, showcasing the practicality and resilience of our predictive model. The ensemble model adeptly strikes a balance between machine learning models and statistical logistic regression, rendering notable improvements in sensitivity and specificity, particularly in scenarios marked by imbalanced data. This contribution marks a substantial stride forward in the area of enhancing decision-making and optimizing resource allocation within treatment program management.

Objective: We conducted a large (N = 204) randomized, clinical trial to test the efficacy of parent-child interaction therapy (PCIT) on observed parenting, two key drivers of maladaptive parenting-self-regulation and social cognitions, and child behavior outcomes in a sample of child welfare-involved families. Method: Participants were randomly assigned to standard PCIT (n = 120) or services-as-usual (SAU; n = 84). The sample was characterized by low household income, significant exposures to adverse childhood experiences, and substance abuse. Intention-to-treat analyses were conducted on multiply imputed data followed by secondary per-protocol analyses. Results: Significant PCIT effects emerged on (a) increased positive parenting, reduced negative parenting and disruptive child behavior (small-to-medium intention-to-treat effects and medium-to-large per-protocol effects); (b) gains in parent inhibitory control on the stop-signal task (small-to-medium effects); (c) gains in parent-reported emotion regulation and (d) positive, affirming self-perceptions (small-to-medium effects), relative to the SAU control group. PCIT's effects on gains in parent emotion regulation were mediated by reductions in observed negative parenting. No differences in rates of parent commands or child compliance were observed across conditions. Harsh child attributions moderated treatment impact on parenting skills acquisition. PCIT parents who held harsher attributions displayed greater gains in use of labeled praises and declines in negative talk/criticism with their child, than control group parents. Conclusions: This randomized trial presents the first evidence that PCIT improves inhibitory control and emotion regulation in a child welfare parents and replicates other published trials documenting intervention gains in positive parenting and child behavior in child welfare families.

Insurance companies and the Centers for Medicaid and Medicare Services are shifting from reimbursing health providers a fixed amount for a service to reimbursement based in part on patients' outcomes. This approach is called value-based care (VBC) and includes a wide range of programs. Although the behavioral health providers that have been impacted by VBC to date are primarily those in larger health systems, use of VBC is expanding as payors seek to combat rising health care costs and increase transparency and accountability for health services. Thus, behavioral health providers need to know about VBC models and their impact as well as steps they can take to be better prepared for this shift.

The present study describes the efforts of a home visiting (HV) continuous quality improvement learning collaborative aimed at increasing father engagement in HV and parenting. Local implementing agencies (n = 11) delivering 3 evidence-based HV models participated in the collaborative. Each agency developed and implemented 3 rapid-cycle Plan-Do-Study-Act (PDSA) projects to increase father engagement. Specific, Measurable, Achievable, Realistic, Time-bound (SMART) aims were used to guide development of change strategies and meaningful measurement goals. HV providers collected data from enrolled families (n = 714) about fathers' level of parenting and HV involvement. Mean father engagement scores increased 39% from the first to the second assessment and over 60% of the PDSAs met or exceeded their SMART aim goal. Data suggest that fathers are open to participating in HV and are responsive to parenting guidance. In the current paper, we share engagement strategies and lessons learned during the collaborative.

BACKGROUND:Adverse childhood experiences are associated with poverty, and public benefit programs are increasingly used as primary prevention for negative child outcomes. OBJECTIVE:To estimate the association between spending on benefit programs and cumulative exposure to ACEs among children. PARTICIPANTS AND SETTING:Children aged 0-17 years in the United States during 2016-17 as reported in National Survey of Children's Health. METHODS:We examined the sum of state and federal spending on 5 categories of public benefit programs at the state-level. The primary exposure was mean annual spending per person living below the Federal poverty limit across 2010-2017 Federal fiscal years. The primary outcome was children <18 years old having ever been exposed to ≥ 4 ACEs. RESULTS:Nationally, 5.7 % (95 % confidence interval [CI] 5.3 % - 6.0 %) of children had exposure to ≥ 4 ACEs. After adjustment for children's race and ethnicity, total spending on benefit programs was associated with lower exposure to ≥ 4 ACEs (odds 0.96 [95 % CI: 0.95, 0.97]; p < 0.001). Increased spending in each individual benefit category was also associated with decreased cumulative ACEs exposure (all p < 0.05). Inverse associations were largely consistent when children were stratified by race and ethnicity and income strata. CONCLUSIONS:Investments in public benefit programs may not only decrease poverty but also have broad positive effects on near- and long-term child well-being beyond the programs' stated objectives. Findings support federal and state efforts to prioritize families' economic stability as part of a public health model to prevent ACEs.

Home visiting programs are an evidence-based approach to reducing adversity exposure and promoting well-being in children experiencing high-risk factors. Despite decades of research demonstrating the benefits of these programs, barriers continue to impact enrollment, engagement, and retention over time. The present qualitative study explored home visiting providers’ perceptions of the behaviors they use to promote enrollment and engagement and reduced attrition for families. Twenty-one providers of three home visiting models (Nurse-Family Partnership, Parents as Teachers, and SafeCare) completed in-depth, semi-structured interviews to probe into provider behaviors that might improve program outcomes. Qualitative data analysis of interviews was conducted using NVivo software with a template approach used to identify broad themes. Findings indicated differences in provider behaviors across enrollment (provider approach and outreach), engagement (provider support and communication), and retention (provider sharing resources and setting goals). Across all three, providers emphasized the importance of building rapport. Implications suggest that workforce structure and training include behavioral strategies to improve enrollment, engagement, and retention in programs to promote program and familial success.

Boswell et al. (2022) persuasively make the case for and propose professional practice guidelines (PPG) for measurement-based care (MBC). Although the evidence for MBC is robust, implementing MBC effectively in practice requires skills and processes not discussed in the PPG. We discuss five problems with the PPG for MBC: The "what's in a name?" problem, lack of actionable actions problem, the stopwatch problem, the stock market problem, and looking for the keys under the light problem. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Home-based parenting programs provide one-on-one coaching to help parents experiencing high-risk factors (e.g., living in poverty, substance abuse, mental health issues, interpersonal violence) to learn safety, health, and parenting skills. Although these programs are empirically-supported and available to the community, they reach only a small proportion of the population in need of services. As such, there is a critical need to improve efforts to inform eligible families and engage them in services. The present study incorporates existing information search theory into a qualitative study of eligible families to understand factors related to successful online marketing of home-based parenting programs. Forty-nine families experiencing risk factors associated with child maltreatment were presented with a marketing website for home-based parenting programs and then interviewed in an effort to understand best practices for marketing these services. Themes emerge regarding the importance of positive content, useful resources, program contact information, clear enrollment instructions, and specific program details. Overall, findings have implications for ways to successfully market home-based parenting programs to families experiencing risk factors for child maltreatment and engage them in evidence-based services to promote family well-being.

INTRODUCTION:We analyzed data from a prospective cohort of older primary care patients to determine whether the presence of peripheral neuropathy (PN) was associated with premature mortality and to investigate potential mechanisms. METHODS:PN was defined as the presence of 1 or more bilateral lower extremity sensory deficits detectable by physical examination. Mortality was determined from key contacts and Internet sources. Statistical models were used to evaluate the association between PN and mortality. RESULTS:Bilateral lower extremity neurological deficits were common, reaching 54% in those 85 and older. PN was strongly associated with earlier mortality. Mean survival time for those with PN was 10.8 years, compared with 13.9 years for subjects without PN. PN was also indirectly associated through impaired balance. CONCLUSIONS:In this relatively healthy cohort of older primary care patients, PN detectable by physical examination was extremely common and strongly associated with earlier mortality. One possible mechanism involves loss of balance, though our data were insufficient to determine whether poor balance led to injurious falls or to less-specific declines in health. These findings may warrant further studies to determine the causes of age-associated PN and potential impact of early detection and balance improvement and other fall prevention strategies.

Early adversity predicts increased risk for mental and physical health problems. As such, intervention efforts, such as home-based parenting programs, have been initiated with vulnerable families to reduce adversity exposure and promote child well-being. The present randomized clinical trial had a parallel design and 1:1 allocation ratio of SafeCare augmented for an urban high-risk population (SC+) compared to standard home-based mental health services (SAU) to examine risk and protective factors proximal to child maltreatment. Parents (N=562) of young children (5 years or less) at risk of depression, intimate partner violence, or substance abuse were randomized to SC+ or SAU. A significant program effect was found in favor of SC+ for parental depression and social support, as well as within-group improvements for both groups in depression, intimate partner victimization, family resources, and social support. Promising next steps include future trials examining how improvements in parental depression and social support impact child well-being over time and further augmentation of SafeCare to enhance healthy relationships and address cultural congruency of services.