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Objectives: To examine the impact of geographic access to providers on treatment engagement and treatment completion in children and adolescents with newly diagnosed depression. Methods: A retrospective cohort study was conducted in using 2013 to 2016 data from a Medicaid Managed Care plan in Texas. Children and adolescents aged 4-18 years and received depression treatment following an incident depression diagnosis were identified. Treatment engagement was defined as $2 visits for psychotherapy or .=2 antidepressant prescriptions. Treatment completion was defined as $8 sessions of psychotherapy or 84 days of antidepressants out of 114 days post-the index treatment. Three measures for geographic access to providers were the travel distance to the providers who initiated the treatment; the density of mental health specialists per 10,000 population within a 5-mile circle from the population weighted centroid of each patient's zip code, and the density of PCPs. Results: 3,472 children and adolescents who met the inclusion criteria were identified. The findings of the multivariable logistic regression analysis showed that travel distance to the provider who initiated the treatment was negatively associated with the likelihood of treatment engagement only among Hispanics (5-15 miles vs. 0-4.9 miles: OR=0.74, 95%CI [0.54-0.88]; .15 miles vs. 0-4.9 mile: OR=0.82, 95%CI [0.56-0.97]). While, the travel distance to the provider who initiated treatment was associated with reduced likelihood of treatment completion in all racial/ethnic groups. Those who lived 15 miles or more away from the provider who initiated the treatment were 22% less likely to complete the treatment than those who traveled less than 5 miles (OR=0.78, 95%CI[0.55-0.93]. Conclusions: Geographic access to providers had a significant effect on both treatment engagement and treatment completion for pediatric depression. As compared to Whites, Hispanics were more sensitive to travel distance to provider and less likely to engage in and complete the treatment.

Kangaroo Mother Care is a key component of effort to reduce the neonatal mortality, enhance the mother knowledge and practice to improve the child health. The use of simulation for increase the knowledge, practice of the mother for effective KMC has been widespread growth and adaption across maternity institution. The present study aimed to assess the effectiveness of simulation on knowledge and practice among the mother or family member in order to improve the mother knowledge and practice level, also enhance the neonatal health. The objective of the study were to assess the knowledge and practice of the mother about KMC and to find out correlation of knowledge with practice on KMC.An experimental research with one group pre-test post having 50 sample were collected by convenience sampling technique. The study found that; the mean of post-test(6.12) is significantly higher than mean pre-test (4.16) knowledge scores and the mean of post-test(8.22)practice score also higher than mean pre-test (4.32) practice scores. Hence it was concluded that KMC is the best method for mother and baby. Stimulation based study assist confidence while enhancing the mother ability to knowledge and practice about KMC.

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