Background: Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC). Methods: This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews. Results: Overall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families. Conclusions: Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers’ insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.

Many individuals make financial, health and food related trade-offs to cope with the challenges of food insecurity and to meet their household needs for healthy, affordable food. A survey (n = 652) was conducted in nine rural counties in South Carolina, USA, during the COVID-19 pandemic from August 2020 to July 2021. We examine if level of food insecurity predicts hunger-coping trade-offs, and whether this relationship is moderated by easiness in food access and dependence on different food source types. Nearly one-third of the respondents experienced food insecurity. Making trade-offs between paying for food and other household expenses was common among the rural residents as on average they made nearly one type of trade-off in the past three months. The number of trade-offs was the highest among highly food insecure respondents (mean = 2.64), followed by moderately food insecure respondents (mean = 1.66); low food insecure respondents had the lowest number of trade-offs (mean = 0.39). The moderating effects of easiness in food access and dependence on food sources varied by level of food insecurity. The results show that individuals at different levels of food insecurity use different strategies to fulfill their food needs and social programs are more often utilized than personal food sources. We conclude with implications for addressing food insecurity in order to reduce the possibility of making trade-offs.

BACKGROUND: We examined trends in mental health service utilization before, during, and in the immediate return to in‐person learning throughout the COVID‐19 pandemic.METHODS: Retrospective chart review was assessed for changes in odds of any visit being a mental health encounter from five school‐based health centers from the 2018‐2019 to the 2021‐2022 school years. Data are limited to the in‐person school year from mid‐August to early June.RESULTS: Data were assessed from 1239 students seen through 2256 visits over the 4 school years (M_age = 12.93). The odds of any visit being related to a mental health encounter increased each school year, with the 2020 to 2021 and 2021 to 2022 school years having significant increases in odds (both compared to the first and to the antecedent school year). In addition, during the 2019 to 2020 and 2020 to 2021 school years, the odds of a repeated mental health encounter significantly increased from year to year.CONCLUSIONS: Findings indicate a steadily increasing number of mental health service utilization needs among adolescent students that was significantly exponentiated throughout the COVID‐19 pandemic.

Youth with autism spectrum disorder (ASD) are at nearly twice the risk of experiencing obesity, compared to youth without ASD. W ellness E ducation to C reate H ealthy habits and A ctions to T hrive ( WE CHAT ) is a novel chatbot that engages participants to enhance primary care delivery and associated care coordination services through mobile health (mHealth) technology focused on social determinants of health (SDOH) and social-emotional health. This study examines multiple perspectives regarding the development and implementation of innovative mHealth technology among youth with ASD. The phases of this study include (1) discussion among individuals and parents of children with ASD, (2) in-depth interviews with primary care providers (PCPs) who treat youth with ASD, and (3) in-depth interviews with interdisciplinary rehabilitation providers who treat youth with ASD. Phases 1 and 2 employed rapid qualitative analysis, and Phase 3 involved inductive thematic analysis to provide context to gaps identified in prior phases. Key themes across the three phases included the variability of symptoms among individuals with ASD , the differences in perceived value of mHealth technology , the importance of family-centered care , and the role of interdisciplinary support . Participants recommended the development of branching logic to increase the flexibility of mHealth technology designed for youth with ASD. This study gathered insight from multiple perspectives to identify opportunities for supporting independent participation in mHealth technology while reducing associated caregiver burden among youth with ASD. These findings may inform refinement and expansion of WE CHAT for patients with varying health needs.

In 2021, national leaders in the United States declared a “national youth mental health crisis.” Still, only 1-in-4 children receive adequate mental healthcare access. Patient Navigator Programs (PNPs) can improve children’s referral-to-connection to mental health services. We examined patient- and community-level factors associated with pediatric mental healthcare access. Pediatric Support Services (PSS) is a PNP that triages mental and behavioral health referrals within a large health system in a southeastern state. This study analyzes PSS data from September 2017-March 2023 and Child Opportunity Index 2.0 state-normed zip-code level data to assess social drivers of health estimates. Structural equation modeling was conducted between patient- and community-level factors and connection to mental health services. Overall, 62.7% of children connected to mental health services since PSS’ inception. Regardless of SDOH, as children get older, they are more likely to connect with mental health services (β = .053, SE = .010, p < .001). Children with greater number of referral needs are more likely to connect with mental health services (β = .034, SE = .011, p = .002). Further, children who live in communities with higher opportunity levels are more likely to connect with mental health services (β = .016, SE = .008, p = .040), suggesting that children who live in low-income communities experience more barriers to mental healthcare. Social drivers may inform referral practices and tiered navigation support for optimal mental healthcare access among children. Further research should demonstrate the effectiveness of PNPs integrated within healthcare and community-based settings.