48 - Prescriptions (Rx) for Prevention: Clinical Tools for Integrating Environmental Health into Pediatric Clinical Care.

Stream: Specific Issues

Wednesday, October 23, 2024

5:30 PM - 7:00 PM PST

Abstract Information: The integration of environmental health (EH) into routine clinical care for children is in its early stages. The vision of pediatric EH is that all clinicians caring for children are aware of and able to help connect families to needed resources to reduce harmful environmental exposures and increase health-enhancing ones. Environmental exposures include air pollution, substandard housing, lead, mercury, pesticides, consumer products chemicals, drinking water contaminants, industrial facility emissions and, increasingly, climate change-related extreme weather and heat events. An identified need is to simultaneously educate clinicians while connecting families to evidence-based EH interventions. Here, we describe a multi-decadal effort to create, refine, and disseminate a clinical tool called Prescriptions (Rxs) for Prevention that responds to that identified need. These tools are modeled on a risk communication framework and use a format that support clinicians to screen their patients for EH concerns, counsel on those topics, and then refer to EH resources if needed. Clinicians now use Rxs for Prevention – tailored with local resources - at a dozen or more sites in multiple regions of the U.S. supporting the promotion of healthy homes, communities, and the broader environment for children. As the integration of EH into children’s clinical care is a nascent effort, a strong and harmonized evaluation strategy could bolster this effort across multiple health care settings in many geographies. To that end, we use a mixed methods evaluation framing that incorporates the ‘screen/counsel/refer’ approach described above as a starting point for goal setting and determining targets. We track number of pediatric patients screened, number of families counseled and referred to additional EH resources. With some community partners providing EH services, we tracked completed referrals and use an iterative approach to troubleshoot barriers families may be encountering for accessing services. Additionally, clinicians who use the Rxs were surveyed to assess both how Rxs were “localized” and how clinicians were incorporating the Rxs into their clinical practice with patients. Results indicated that respondents (n=14) used the tool to help standardize key messages and provide actionable next steps for families. Our evaluation also revealed that the Rxs are used in a variety of ways that extend past the clinic walls. This presentation will describe the Rx for Prevention program, how clinicians and researchers are using evaluation data to inform program design and implementation changes, as well as key implications for future practice.

Presenter(s)

Christopher W. Bland, MPH, AE-C

Program Coordinator
Icahn School of Medicine at Mount Sinai, United States

Author(s)

LZ

Lauren Zajac, MD, MPH

Clinical Director
Icahn School of Medicine at Mount Sinai, United States
JW

Joseph Wilson Jr., MHS

Doctoral Student
Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, United States
LG

Luz Guel, BA

Director
Icahn School of Medicine at Mount Sinai, United States
SP

Sofia C. Pendley, PhD, MPH

Assistant Professor
Icahn School of Medicine at Mount Sinai, United States
AC

Annemarie Charlesworth, MA

Research Specialist
Environmental Research and Translation for Health (EaRTH) Center, University of California San Francisco, CA, United States
KK

Katrina Korfmacher, PhD

Director
Environmental Health Sciences Center at Department of Environmental Medicine, University of Rochester Medical Center, United States
NN

Nicholas Newman, DO, MS

Medical Director
Pediatric Environmental Health and Lead Clinic at Cincinnati Children's Hospital Medical Center, United States
MH

Marilyn Howarth, MD

Deputy Director
Center of Excellence in Environmental Toxicology, Perelman School of Medicine, United States
sB

sophie Balk, MD

General Pediatrician
Division of Academic General Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, United States
mG

maida Galvez, MD, MPH

Co-Director
Icahn School of Medicine at Mount Sinai, United States
PS

Perry Sheffield, MD, MPH

Co-Director
Icahn School of Medicine at Mount Sinai, United States