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Nearly 1 in 6 children in the United States has a chronic illness ordisability. Prior research has shown that these children are at risk for psychologicaland emotional problems as a result of their chronic illnesses. In this article,Chernoff and colleagues report the results of a randomized, controlled trialof a 15-month family-based intervention to enhance the self-esteem of childrenwith chronic illness. The intervention had a substantial effect on improvingself-esteem, especially among children with low self-esteem at the beginningof the trial. The intervention may be generalizable to other children withchronic illnesses and can be delivered in a variety of settings.
For the last decade, guidelines have recommended daily use of controllermedications for children with persistent asthma. This survey of 1648 childrenwith asthma who were insured by Medicaid and enrolled in 1 of 5 managed careplans in Washington, Massachusetts, or California found that 59% had persistentasthma, half of whom reported no controller medication use. Having a regularprimary care physician, a written action plan, and scheduled follow-up visitswere each associated with a doubling in the likelihood of controller medicationuse. Implementation of these system changes can result in improved controlof asthma in children.
Some health plans have abandoned gatekeeping by primary care physiciansbecause it is not found to be cost-effective. In this study of a capitatedmultispecialty group, elimination of gatekeeping did not increase the numberof visits to specialists. Visits to any specialist by children with chronicconditions increased slightly. This study confirmed that replacing gatekeepingwith open access to all specialty physicians in a managed care organizationresulted in minimal changes on children's utilization of specialists.
Primary care physicians are paying increasing attention to children'smental health problems and the need for appropriate intervention and treatment.This sometimes includes referral to a mental health specialist. Rushton andcolleagues analyzed data from 4012 patients with identified psychosocial problemswho had been followed in the Child Behavior Study. One in 6 children was referredto a mental health specialist at their initial visit, although fewer thantwo thirds of these children actually saw a specialist in the subsequent 6months.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2002;156(6):528. doi:10.1001/archpedi.156.6.528
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