Browsing Han Publications without organization data by Author "Cushwa, A."

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Characterization of Social Risk Factors Among Newborns Seen at an Urban Pediatric Primary Care Predictive of Appointment Nonattendance During the First 6 Months of Life.
Lefchak, B. ; Cushwa, A. ; Kersten, H. ; Courts, K. ; McPeak, K.
2022, Article / Letter to editor (Health Equity, vol. 6, iss. 1, (2022), pp. 40-48)Purpose: Appointment attendance is critical in monitoring health and well-being of children. Low income Medicaid-insured families with newborns often experience social risks that may affect attendance. This project sought to characterize social risk factors present at first newborn visits predictive of future appointment nonattendance. Methods: Retrospective cohort study of minority and Medicaid-insured population at St. Christopher's Hospital for Children using a standardized social risk screener administered at first newborn visits as part of routine clinical care. In total, 720 survey responses between December 2016 and June 2017 were correlated with electronic health record-derived sociodemographic and appointment attendance data in the first 6 months of life. Nonattendance included missed and canceled appointments. Caregiver-reported social risk factors were included as covariates in linear regressions predicting proportion nonattendance outcomes. Results: Newborn caregivers identified many social risk factors including mental health diagnoses (14%), lack of child care support (45%), and food insecurity (9%). Approximately 74% had nonattendance with 41% missing or canceling a quarter or more appointments. Number of siblings (p<0.01) and maternal age (p<0.01) were most predictive for nonattendance, respectively. Other social risks were not significant except for maternal mental health (p=0.01) among those identifying number of risk factors above cohort average (16%). Conclusion: Screening of newborns at first medical visits can be used to characterize social risks. Most social risk factors at first visits were not strongly predictive of nonattendance, although our results suggested associations between non-attendance and maternal demographics, mental health and household makeup.
Understanding Caregiver Perspective on Social Determinants of Health Interventions in Pediatric Primary Care.
Corey, J.R. ; Courts, K.A. ; Anshu, P. ; Cushwa, A. ; Kersten, H.B.
2022, Article / Letter to editor (Population Health Management, vol. 25, iss. 2, (2022), pp. 172-177)Comprehensive social risk screening has become standard practice in primary care. Evidence is lacking, however, on whether and how interventions provided for positive screens are being utilized. This study aimed to create a standardized follow-up process to evaluate caregiver perspective and usage of community resources provided during well-child visits. Follow-up calls were made to families with positive screens for food insecurity (FI) and/or utility insecurity (UI) (nn=n347). Phone interviews assessed resource usage, effectiveness, influence on stress level, and current insecurity status. Caregiver responses regarding barriers to resource usage were inductively analyzed and developed into major themes. The sample included 228 (65.7%) families with positive screens for FI and 166 (47.8%) families screening positive for UI. Of those who completed interviews (nn=n108), 77 (71.3%) caregivers recalled being provided resources during their child's visit with only 33 (42.9%) reporting use of those resources. Twelve (36.4%) of those caregivers who used the resources confirmed that their insecurity was still a concern. Five major themes for barriers to resource usage emerged: (1) improved situation, (2) perception, (3) access barriers, (4) conflicting priorities, and (5) too busy/overwhelmed. The majority of caregivers (95.7% of asked) noted that their insecurity caused increased stress with 70.5% acknowledging decreased stress levels after discussion with a provider. Integrating caregiver input through a standardized follow-up protocol into provided interventions for screened social risks can improve not only the quality and effectiveness of provided resources, but also provide insight into the impact of those interventions on insecurity from the caregiver perspective.

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