Latinos are the fastest-growing ethnic minority group in the U.S. We propose a culturally-relevant group well-child care model for Latino families with children under two, implemented in an urban academic center with Medicaid-insured patients. Twenty-five families completed an average of 7.2 group visits of nine recommended well-childchecks.

Objective To assess how frequently pediatric practitioners perform latent tuberculosis infection (LTBI) screening according to guidelines. We hypothesized that screening occurs less frequently among children whose parents do not speak English as the primary language. Study design We conducted a retrospective cohort study of patients attending well-child visits in an urban academic pediatric primary care clinic from 4/1/2012–3/31/2013. We assessed documentation of three LTBI screening components and tested the association between parent primary language and tuberculin skin test (TST) placement and documentation of results. Results During the study period, 387 of 9,143 (4%) children had no documentation of screening question responses. Of the other 8,756 children, 831 (10%) were identified as high-risk for LTBI. Of these, 514 (62%) did not have documented TST administration in the appropriate time frame. Thirty-nine of 213 (18%) children who had a TST placed did not have documented results. Multivariable regression showed that parent language was not associated with TST placement or documentation of results, but non-Hispanic Black children were more likely not to have a documented test result (aOR 2.12, 95% CI 1.07–4.19, P=0.03) when adjusting for age, sex, parent primary language, insurance status, day of the week and study year of TST placement. Conclusions Parent primary language was not associated with LTBI testing. However, we found substantial gaps in TST placement and documentation of TST result among high-risk children, the latter of which was associated with race/ethnicity. Targeted quality improvement efforts should focus on developing processes to ensure complete screening in high-risk children.

The authors describe Monster, P.I., which is an app‐based, gamified assessment that measures language skills (knowledge of morphology, vocabulary, and syntax) of students in grades 5–8 and provides teachers with interpretable score reports to drive instruction that improves vocabulary, reading, and writing ability. Specifically, the authors describe why an assessment of language is important to include, the components of language that are assessed by Monster, P.I., and how Monster, P.I., uses gamification to add enjoyment and motivation to the assessment experience. The authors then explain how to use Monster, P.I., to inform instructional decisions, specifically explaining the overall instructional framework, what each score means, and examples of instruction that link to each area assessed by the app. Links to Common Core State Standards are included. The authors conclude by sharing teachers’ feedback on the assessment and how they used it to support instruction in their classrooms.

Assessment of language skills for upper elementary and middle schoolers is important due to the strong link between language and reading comprehension. Yet, currently few practical, reliable, valid, and instructionally informative assessments of language exist. This study provides validation evidence for Monster, P.I., which is a gamified, standardized, computer-adaptive assessment (CAT) of language for fifth to eighth grade students. Creating Monster, P.I. involved an assessment of the dimensionality of morphology and vocabulary and an assessment of syntax. Results using multiple-group item response theory (IRT) with 3,214 fifth through eighth graders indicated morphology and vocabulary were best assessed via bifactor models and syntax unidimensionally. Therefore, Monster, P.I. provides scores on three component areas of language (multidimensional morphology and vocabulary and unidimensional syntax) with the goal of informing instruction. Validity results also suggest that Monster, P.I. scores show moderate correlations with each other and with standardized reading vocabulary and reading comprehension assessments. Furthermore, hierarchical regression results suggest an important link between Monster, P.I. and standardized reading comprehension, explaining between 56% and 75% of the variance. Such results indicate that Monster, P.I. can provide meaningful understandings of language performance which can guide instruction that can impact reading comprehension performance.

Developing improved systems of care for children with special health care needs (CSHCN) requires accurate identification and stratification of this population. This study was designed to assess the ability of a brief screener to identify and stratify CSHCN in a primary care clinic to focus future quality improvement initiatives and allocate resources. All families presenting for health maintenance visits or acute care appointments at an academic primary care clinic between September 5, 2012 and September 28, 2012 were asked to complete the CSHCN Screener©. This panel of patients was compared to registries previously created by: (1) retrospective chart reviews using published lists of International Statistical Classification of Diseases and Related Health Problems (ICD9) codes for CSHCN and (2) direct physician referral to a clinic case manager providing care coordination services to CSHCN. Screeners identified 246 CSHCN (16.8 % of unique completed screeners). Scores ranged from 0 to 5; higher scores indicate higher levels of complexity. Patients with positive screens had a mean score of 2.4. Patients previously identified by retrospective ICD9 search who completed a screener had a mean score of 1.6 with nearly one-half having negative screens. Patients previously identified by physician referral who completed a screener had a mean score of 2.7 with nearly one-half having scores of 4 or 5. The CSHCN Screener© can be utilized in an academic primary care clinic to prospectively identify CSHCN and potentially offers a more clinically meaningful method of identification given its inherent ability to stratify this population based on complexity of medical needs.