The average American adult reads at an 8th-grade level. Discharge instructions written above this level might increase the risk of adverse outcomes for children as they transition from hospital to home. We conducted a cross-sectional study at a large urban academic children's hospital to describe readability levels, understandability scores, and completeness of written instructions given to families at hospital discharge. Two hundred charts for patients discharged from the hospital medicine service were randomly selected for review. Written discharge instructions were extracted and scored for readability (Fry Readability Scale [FRS]), understandability (Patient Education Materials Assessment Tool [PEMAT]), and completeness (5 criteria determined by consensus). Descriptive statistics enumerated the distribution of readability, understandability, and completeness of written discharge instructions. Of the patients included in the study, 51% were publicly insured. Median age was 3.1 years, and median length of stay was 2.0 days. The median readability score corresponded to a 10th-grade reading level (interquartile range, 8-12; range, 1-13). Median PEMAT score was 73% (interquartile range, 64%-82%; range, 45%-100%); 36% of instructions scored below 70%, correlating with suboptimal understandability. The diagnosis was described in only 33% of the instructions. Although explicit warning signs were listed in most instructions, 38% of the instructions did not include information on the person to contact if warning signs developed. Overall, the readability, understandability, and completeness of discharge instructions were subpar. Efforts to improve the content of discharge instructions may promote safe and effective transitions home. Journal of Hospital Medicine 2017;12:98-101.

More parental adversity and less resilience are associated with parental coping difficulties after discharge, representing potentially important levers for transition-focused interventions.

Research Summary  Precursors to serious and chronic delinquency often emerge in childhood, stimulating calls for early interventions. Most intervention efforts rely solely on social service programs—often to the exclusion of the juvenile justice system. The juvenile justice system has been reluctant to become involved in the lives of relatively young children fearing net widening or further straining resources that could be used for older youth with documented delinquency histories. We report here the results of an early intervention program sponsored by and housed in a district attorney's office in Louisiana. Using a quasi‐experimental design, we examined outcomes associated with program involvement as well as whether the obvious involvement of the prosecutor's office was associated with further reductions in problem behavior. The results revealed that significant reductions in problem behaviors of young children could be attributed to program participation. The obvious involvement of the district attorney's office, however, was associated with limited, albeit significant, reductions in specific problem behaviors. These findings show that successful early intervention efforts can be made part of the juvenile justice system and that in some limited situations prosecutorial involvement can result in positive outcomes. Policy Implications  The expansion of early intervention programming into the juvenile justice system offers opportunities to address early problem behavior. Our study and its results have the following policy implications. Closely coupled partnerships between schools and the juvenile justice system can effectively address, mitigate, and perhaps prevent an early onset of antisocial behavior. Even so, coupling early intervention efforts to the mission of the juvenile justice system warrants debate. Net‐widening, resource diffusion, and the potential for officials to rely too heavily on the deterrent characteristics of the justice system represent serious threats to the integrity of effective early intervention programs. We suggest substantial debate and consideration is given before coupling early intervention efforts to the juvenile justice system.

BACKGROUND: Adverse childhood experiences (ACEs) are associated with poor health outcomes in adults. Resilience may mitigate this effect. There is limited evidence regarding how parents’ ACEs and resilience may be associated with their children’s health outcomes. OBJECTIVE: To determine the association of parental ACEs and resilience with their child’s risk of unanticipated healthcare reutilization. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective cohort study (August 2015 to October 2016) at a tertiary, freestanding pediatric medical center in Cincinnati, Ohio. Eligible participants were English-speaking parents of children hospitalized on a Hospital Medicine or Complex Services team. A total of 1,320 parents of hospitalized children completed both the ACE questionnaire and the Brief Resilience Scale Survey. EXPOSURE: Number of ACEs and Brief Resilience Scale Score among parents. MAIN OUTCOMES: Unanticipated reutilization by children, defined as returning to the emergency room, urgent care, or being readmitted to the hospital within 30 days of hospital discharge. RESULTS: In adjusted analyses, children of parents with 4 or more ACEs had 1.69-times higher odds (95% Confidence Interval 1.11-2.60) of unanticipated reutilization after an index hospitalization, compared with children of parents with no ACEs. Resilience was not significantly associated with reutilization. CONCLUSION: Parental history of ACEs is strongly associated with higher odds of their child having unanticipated healthcare reutilization after a hospital discharge, highlighting an intergenerational effect. Screening may be an important tool for outcome prediction and intervention guidance following pediatric hospitalization.

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