Joyce R. Javier

Children with Special Health Care Needs: How Immigrant Status is Related to Health Care Access, Health Care Utilization, and Health Status

To compare health care access, utilization, and perceived health status for children with SHCN in immigrant and nonimmigrant families. This cross-sectional study used data from the 2003 California Health Interview Survey to identify 1404 children (ages 0–11) with a special health care need. Chi-square and logistic regression analyses were used to examine relations between immigrant status and health access, utilization, and health status variables. Compared to children with special health care needs (CSHCN) in nonimmigrant families, CSHCN in immigrant families are more likely to be uninsured (10.4 vs. 4.8%), lack a usual source of care (5.9 vs. 1.9%), report a delay in medical care (13.0 vs. 8.1%), and report no visit to the doctor in the past year (6.8 vs. 2.6%). They are less likely to report an emergency room visit in the past year (30.0 vs. 44.0%), yet more likely to report fair or poor perceived health status (33.0 vs. 16.0%). Multivariate analyses suggested that the bivariate findings for children with SHCN in immigrant families largely reflected differences in family socioeconomic status, parent’s language, parental education, ethnicity, and children’s insurance status. Limited resources, non-English language, and limited health-care use are some of the barriers to staying healthy for CSHCN in immigrant families. Public policies that improve access to existing insurance programs and provide culturally and linguistically appropriate care will likely decrease health and health care disparities for this population.

Examining Depressive Symptoms and Use of Counseling in the Past Year Among Filipino and Non-Hispanic White Adolescents in California

Objective: We compared measures of depressive symptoms and use of counseling in the past year for Filipino versus non-Hispanic white adolescents in California. Methods: This cross-sectional study used data from 4421 adolescents who completed the 2003 and 2005 California Health Interview Survey. Bivariate analyses, linear regression, and logistic regression were performed. Results: Compared to non-Hispanic white adolescents, Filipino adolescents had higher mean 8-item version of Center for Epidemiologic Studies Depression Scale scores (5.43 vs 3.94) and were more likely to report a clinically significant level of depressive symptoms (defined as 8-item version of Center for Epidemiologic Studies Depression Scale score ≥7) (29.0 vs 17.9%). Filipino adolescents are just as likely as their non-Hispanic white counterparts to report low use of counseling in the past year (17.6 vs 28.4%). Multivariate analyses indicate that depressive symptoms were positively associated with Filipino ethnicity, female gender, living in a single parent household, lower parental education, and poverty. The effect that ethnicity had on use of counseling in the past year varied by gender, income level, and parental education level. Filipino male adolescents with family incomes ≥300% federal poverty level and parents with more than a college degree were significantly less likely than their non-Hispanic white counterparts to report use of counseling in the past year (odds ratio, 0.01; confidence interval, 0.0004–0.44). Filipino female adolescents with family incomes <300% federal poverty level and parental education less than a college degree were significantly more likely to report use of counseling than their non-Hispanic white counterparts (odds ratio, 3.99; confidence interval, 1.00–15.89). Conclusion: Further studies and interventions are needed to effectively screen for and treat depression among Filipino adolescents.

A multi-institutional medical educational collaborative: advocacy training in California pediatric residency programs.

Educational collaboratives offer a promising approach to disseminate educational resources and provide faculty development to advance residents’ training, especially in areas of novel curricular content; however, their impact has not been clearly described. Advocacy training is a recently mandated requirement of the Accreditation Council for Graduate Medical Education that many programs struggle to meet. The authors describe the formation (in 2007) and impact (from 2008 to 2010) of 13 California pediatric residency programs working in an educational collaboration (“the Collaborative”) to improve advocacy training. The Collaborative defined an overarching mission, assessed the needs of the programs, and mapped their strengths. The infrastructure required to build the collaboration among programs included a social networking site, frequent conference calls, and face-to-face semiannual meetings. An evaluation of the Collaborative’s activities showed that programs demonstrated increased uptake of curricular components and an increase in advocacy activities. The themes extracted from semistructured interviews of lead faculty at each program revealed that the Collaborative (1) reduced faculty isolation, increased motivation, and strengthened faculty academic development, (2) enhanced identification of curricular areas of weakness and provided curricular development from new resources, (3) helped to address barriers of limited resident time and program resources, and (4) sustained the Collaborative’s impact even after formal funding of the program had ceased through curricular enhancement, the need for further resources, and a shared desire to expand the collaborative network.

Children in Immigrant Families: The Foundation for America’s Future

Joyce R. Javier, MD, MPH, Natalia Festa, BA, Ellynore Florendo, MS, Fernando S. Mendoza, MD, MPH* Division of General Pediatrics, Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Boulevard MS#76, Los Angeles, CA 90027, USA; Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Stanford, 1265 Welch Road, MSOB 238, Stanford, CA 94305-5459, USA

Cross-Cultural Training in Pediatric Residency: Every Encounter Is a Cross-Cultural Encounter

From the Division of General Pediatrics, Children’s Hospital Los Angeles/University of Southern California Keck School of Medicine, Los Angeles, CA (Dr Javier); Primary Care Department, Touro University College of Osteopathic Medicine, Vallejo, CA (Dr Hendriksz); and General Pediatrics, Stanford University School of Medicine, Palo Alto, CA (Drs Chamberlain and Stuart) The authors declare that they have no conflict of interest. Address correspondence to Joyce R. Javier, MD, MPH, 4650 Sunset Blvd, MS#76, Los Angeles, CA 90027 (e-mail: jojavier@chla.usc.edu).

Prevention of Filipino Youth Behavioral Health Disparities: Identifying Barriers and Facilitators to Participating in "Incredible Years," an Evidence-Based Parenting Intervention, Los Angeles, California, 2012.

Introduction Evidence-based interventions for training parents are proven to prevent onset and escalation of childhood mental health problems. However, participation in such programs is low, especially among hard-to-reach, underserved populations such as Filipino Americans. Filipinos, the largest Asian subgroup in California, have significant behavioral health disparities compared with non-Hispanic whites and other Asian subgroups. The purpose of this study was to learn about Filipinos’ barriers and facilitators to participating in “Incredible Years” (IY), a parenting program. Methods We conducted 4 focus groups in Los Angeles, California, in 2012; the groups consisted of 20 Filipino parents of children aged 6 to 12 years who recently completed the IY parenting program, which was offered as a prevention workshop. Three reviewers, including two co-authors (A.S., J.J.) and a research assistant used content analysis to independently code the interview transcripts and extract subthemes. Grounded theory analytic methods were used to analyze interview transcripts. Results Parents’ perceived benefits of participation in IY were learning more effective parenting techniques, networking with other parents, improved spousal relationships, and improvements in their childrens behavior. Parents’ most common motivating factor for enrollment in IY was to improve their parenting skills and their relationships with their children. The most common barriers to participation were being uncomfortable sharing problems with others and the fear of being stigmatized by others judging their parenting skills. Participants said that parent testimonials would be the most effective way to promote IY. Many recommended outreach at schools, pediatricians’ offices, and churches. Conclusion Increasing Filipino American parent enrollment in IY in culturally relevant ways will reduce the incidence of mental health disorders among children in this growing population.

Preliminary Validity of the Eyberg Child Behavior Inventory With Filipino Immigrant Parents.

Filipinos are an understudied minority affected by significant behavioral health disparities. We evaluate evidence for the reliability, construct validity, and convergent validity of the Eyberg Child Behavior Inventory (ECBI) in 6- to 12-year-old Filipino children (N = 23). ECBI scores demonstrated high internal consistency, supporting a single-factor model (preintervention α = .91; postintervention α = .95). Results document convergent validity with the Child Behavior Checklist Externalizing scale at pretest (r = .54, p < .01) and posttest (r = .71, p < .001). We conclude that the ECBI is a promising tool to measure behavior problems in Filipino children.

Recruiting Filipino Immigrants in a Randomized Controlled Trial Promoting Enrollment in an Evidence-Based Parenting Intervention

Filipinos, the second largest Asian subgroup in the U.S., experience significant youth behavioral health disparities but remain under-represented in health research. We describe lessons learned from using the Matching Model of Recruitment to recruit 215 Filipinos to participate in a large, randomized controlled trial of a culturally tailored video aimed at increasing enrollment in the Incredible Years® Parent Program. We recruited participants from schools, churches, clinics, community events, and other community-based locations. Facilitators of participation included: partnership with local community groups, conducting research in familiar settings, building on existing social networks, and matching perspectives of community members and researchers. Findings suggest recruitment success occurs when there is a match between goals of Filipino parents, grandparents and the research community. Understanding the perspectives of ethnic minority communities and effectively communicating goals of research studies are critical to successful recruitment of hard-to-reach immigrant populations in randomized controlled trials.

Voices of the Filipino Community Describing the Importance of Family in Understanding Adolescent Behavioral Health Needs

Filipinos are a large, yet invisible, minority at high risk for adolescent behavioral health problems. Limited research describes the family as offering a source of positive support for some Filipino youths and yet for some it is also a source of stress and isolation, leading to struggles with adolescent depression and suicidal behavior. This article describes a qualitative study that investigates the role of family when understanding behavioral health needs among Filipino adolescents. Findings highlight the importance of addressing family cohesion when designing interventions aimed at improving the well-being of Filipino youth.