Eve-Lynn Nelson’s research while affiliated with University of Kansas Medical Center and other places

Autistic adolescents and young adults in rural areas often experience more unmet medical needs than their urban peers, particularly during the health care transition, the process of moving from pediatric to adult health care. This study aimed to understand the health care transition experiences of autistic adolescents and young adults (14–25 years old) across rural and urban settings through a structured survey assessing demographics, health care transition experiences, and future health care decision-making planning. Of 180 participants (urban: 96; rural: 84), the average age was 19.67 years. Slightly over half (53.3%) reported completing health care transition at an average age of 18.02 years. Only 40 participants had health care transition discussions with their doctors, typically starting at 17.78 years. Regarding future medical decision-making, autistic adolescents and young adults who completed the survey independently had significantly higher odds of anticipating future independent medical decision-making compared to those who had parental assistance in survey completion (odds ratio = 6.601, 95% confidence interval: 2.857–15.250, p < .001). These results emphasize the need for enhanced health care transition support for autistic adolescents and young adults, suggesting that health care transition should be integrated into broader transition planning, and tailored interventions should be developed to improve health care transition outcomes for adolescents and young adults, their caregivers, and providers. Lay abstract Autistic adolescents and young adults in rural areas face significant challenges in health care transition compared to their urban counterparts. Health care transition, the process of moving from pediatric to adult health care, is crucial for the long-term health outcomes of adolescents and young adults. Previous research indicates rural adolescents and young adults often have greater unmet medical and financial needs, affecting their transition experiences, but there was no study focusing on rural autistic adolescents and young adults’ health care transition experiences. This pilot study provides a comparative analysis of the health care transition experiences of rural and urban autistic adolescents and young adults. Ninety-six urban and 84 rural participants (14–25 years old) participated in the study. Their average age was 19.67 years. Just over half of the participants had completed the transition to adult care, typically reporting finishing this process at around 18 years old. A majority had limited discussions with their doctors about transitioning, and those who had discussions often started these conversations late. It also reveals that the responses completed by or with parents of autistic adolescents and young adults tend to indicate that the adolescents and young adults would not make future medical decisions or are uncertain about it. The findings underscore the necessity for targeted support for autistic adolescents and young adults during their health care transition process, regardless of their residence. There is a clear need for targeted health care transition interventions for adolescents and young adults, parents, and health care providers to ensure autistic adolescents and young adults and their families receive adequate support during the health care transition process.

The purpose of this descriptive analysis is to compare patient and encounter characteristics in rural patients who received telehealth versus in-person behavioral health treatment. This study, including over 11,000 rural patients and nearly 35,000 patient encounters, used a non-randomized prospective research design involving two active usual-care treatment groups—a behavioral telehealth treatment group and an in-person behavioral health treatment group. Two-tailed chi-square tests compared treatment groups on patient characteristics and encounter-level variables. Statistically significant differences were found between the telehealth and in-person treatment groups in age, race, ethnicity, primary diagnosis, provider type, service type, insurance status, and treatment billing (all p < 0.001). The telehealth treatment group was more likely to be Hispanic, aged 18 and younger, with ICD-10 diagnoses related to that age group, have government-financed insurance, receive office and outpatient visits for evaluation and management psychiatric services, and be seen by a wide range of providers. The in-person treatment group was more likely to be aged 19–34; have private insurance; have a primary ICD-10 diagnosis of anxiety, dissociative, stress-related, somatoform, and other nonpsychotic mental disorders; receive treatment by clinical social workers; and have 60-min individual therapy. This analysis of real-life data from 95 rural clinic sites in 13 states largely validates national survey data regarding the utilization of telehealth in specific underserved populations but expands these findings to show continued disparities in provider, service, and payer type, which is particularly important for rural communities and pre-existing healthcare equity concerns.

Comments on the article by Shaidullah, et al. (see record 2024-13778-001). Shahidullah and team describe the utilization of the hospital-school-community telepartnership (HSCT), a telehealth program aimed to increase rapid crisis response and interagency care coordination for students with suicidality safety risk. The HSCT team followed both crisis mental health (SAFE-T) and telebehavioral health best practices, with a licensed teleclinician conducting virtual crisis evaluation at the student's school, often on the same day. The HSCT maximized telebehavioral health by simultaneously supporting and consulting with school staff who often serve as de facto crisis mental health with little training or supported time. This collegial cross-system approach resonates with the current author team's experience of the importance of training, including opportunities to validate the supports that school personnel have provided as well as problem solving together to support students in crisis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

e13791 Background: Cancer survivors require long-term, coordinated care to address the physical, emotional, and psychosocial effects of cancer and its treatment. KanSurvive, a single arm feasibility trial, evaluated the effectiveness of the KanSurvive ECHO intervention combined with practice facilitation (PF) to promote better adoption of evidence-based practice (EBP) survivorship care guidelines for breast, colorectal, lung, and prostate cancer among rural survivors. Methods: Fifteen primary care clinics in Kansas (80% in RUCA codes 4-10), including 62 healthcare professionals, were invited to participate in four, 1-hour Project ECHO telementoring program held in 2021. Real-time videoconferencing sessions covered EBP survivorship guidelines for breast, colorectal, lung, and prostate cancer. Clinics used brief plan-do-study-act cycles with PF supporting implementation of the quality improvement process. Utilizing the National Quality Forum framework, a performance indicator booklet with established measures in preventive health and cancer survivorship was developed as a data collection and quality improvement resource. Performance indicators included EBP screening actions related to cancer surveillance, lifestyle factors, distress, evidence of a review of family history of cancer, and the patient’s cancer diagnosis documented in the EHR. Results: Three clinics (7 = healthcare professionals) withdrew from the project citing competing demands and a provider leaving the practice. The COVID-19 pandemic delayed project initiation and prevented clinic visits. Recruitment and study procedures were implemented remotely. Clinic staff identified 138 cancer survivors (M = 13, IQR [6-16] per practice) seen in the year pre-intervention, and 129 survivors in the year prior to post-intervention. Pre-intervention, overall tumor surveillance was 91%, but lung cancer surveillance was lower than other tumor types at 70%. Other than surveillance, measures of baseline performance were similar across tumor types: screening for distress 84%, assessment of BMI 97%, screening for tobacco use 83% and documentation of family history 70%. Post-intervention performance indicators were similar except for documentation of family history which increased to 89% (p < 0.01). Conclusions: Standardized survivorship metrics can facilitate quality assessment as part of an ECHO-based cancer survivorship program. Although there are modest opportunities for improvement, PCPs in this study caring for rural patients perform reasonably well across a variety of cancer survivorship performance metrics comparable to national primary care quality measures. Documented assessment of family history of cancer lags other metrics and improved after participation in the KanSurvive telementoring program.

Background Youth in rural areas are disproportionally affected by obesity. Given the unique barriers rural populations face, tailoring and increasing access to obesity interventions is necessary. Objective This paper evaluates the effectiveness of iAmHealthy, a family‐based paediatric obesity intervention delivered to rural children, compared to a Newsletter Control. Methods Participating schools (n = 18) were randomly assigned to iAmHealthy or Newsletter Control. iAmHealthy consists of individual health coaching and group sessions delivered via televideo to a participant's home. The child and parent's body mass index (BMI), child physical activity and child dietary intake were assessed at baseline, post‐treatment (8 months) and follow‐up (20 months). Multilevel modeling estimated the effect of treatment at both time points. Results Parent and child dyads were recruited (n = 148) and randomised to iAmHealthy (n = 64) or the Control group (n = 84). The Control group had significant increases in child BMIz from baseline to follow‐up. iAmHealthy youth had no significant changes in BMIz from baseline to post or follow‐up. Child dietary intake, physical activity and parent BMI results are also discussed. Conclusions This trial extends previous paediatric obesity work by simultaneously increasing convenience and dose of treatment. Results suggest iAmHealthy resulted in a change in BMIz trajectories and long‐term health behaviour for youth.