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Cultural Adaptation of a Pediatric Functional Assessment for Use by Hispanic Families of Young Children with Special Health Care Needs
Research Posters revealed a significant indirect effect of impaired self-awareness on both anxiety and depression through post-injury self-concept after controlling for covariates. Self-concept accounted for nearly half of the total effect of impaired self-awareness on anxiety and depression, PMZ.43 and PMZ.42, respectively. Conclusions: Poorer awareness of deficits was associated with having a more positive view of self after injury, resulting in fewer anxiety and depressive symptoms. Further research is needed to better understand the role of self-evaluation and self-awareness in the adaptation process of persons with TBI. Key Words: Traumatic brain injury, Self Concept, Awareness, Emotional Adjustment, Rehabilitation Disclosures: None disclosed. Research Poster 809 Cultural Adaptation of a Pediatric Functional Assessment for Use by Hispanic Families of Young Children with Special Health Care Needs Kristen Arestad (Colorado State University), Erin Albrecht, Lauren Nale, Pat Sample, David MacPhee, Chun Yi Lim, Mary A. Khetani Research Objectives: To compare and examine the feasibility of culturally adapting the Young Children’s Participation and Environment Measure (YC-PEM) with and without language translation for use by caregivers of children with special health care needs (CSHCN) who are of Mexican descent. Design: Cross-sectional, descriptive study. Setting: Questionnaire data were administered by electronic and paper methods to eligible families of CSHCN receiving services. Participants: 7 caregivers (4 Spanish-speaking; 3 English-speaking) raising CSHCN of Mexican descent between 0-5 years old were recruited by early intervention providers and the principal investigator. Interventions: Caregivers completed a demographic questionnaire, Acculturation Rating Scale for Mexican Americans-II, and YC-PEM inclusive of cognitive testing items. Responses to cognitive testing items were content coded to established cultural equivalencies (i.e., semantic/ idiomatic, item, conceptual) by up to 4 research staff. Coded data were summed to compare frequency of revisions needed to achieve cultural equivalence between the two versions. Enrollment and process data were used to examine the feasibility of language translation and cognitive testing. Main Outcome Measure(s): YC-PEM cognitive testing items and data on feasibility of resources, data collection procedures, and data quality. Results: More revisions were required to achieve cultural equivalence for the translated (Spanish) version. However, conceptual equivalence concerns were identified in both versions. Feasibility results revealed that 1) language translation processes required high resource investment, but increased translation quality as evidenced by decreased discrepancy rates, and 2) use of questionnaire (i.e., electronic, paper) versus interview methods may have limited data saturation for cognitive testing results. Conclusions: Results lend preliminary support to the need for and feasibility of cultural adaptation with and without language translation, and have informed protocol revisions for a study underway to confirm findings. Key Words: Infant, child, preschool, culture, consumer participation Disclosures: None disclosed. Research Poster 811 Equity in Access to Outpatient Rehabilitation Services For Children With Traumatic Brain Injury and Public Insurance Molly Fuentes (University of Washington), Leah Thompson, Susan Apkon, Karin Rhodes, Cheryl Kerfeld, Deborah Kartin, Frederick P. Rivara Research Objectives: Identify insurance-based disparities in access to outpatient rehabilitation services for children.
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e135 Design: Audit study using paired telephone calls by callers posing as mother of a child with history of severe TBI seeking outpatient rehabilitation services. Setting: Outpatient rehabilitation service clinics in Washington State. Participants: 195 Physical Therapy (PT), 109 Occupational Therapy (OT), 102 Speech Therapy (ST) and 11 Rehabilitation Medicine clinics. Interventions: Not applicable. Main Outcome Measure(s): Offer of appointment at clinic and wait time in work days until the next available appointment. Results: Therapy clinics were more likely to accept private versus public insurance (relative risk (RR) for PT 1.33 (95% confidence interval (CI) 1.22-1.44), for OT 1.40 (95% CI 1.24-1.57), and for ST 1.42 (95% CI 1.251.62)), but there was no significant difference for Rehabilitation Medicine clinics (RR 1.10, 95% CI 0.90-1.34). The difference in median wait time between clinics that accepted public versus only private insurance was 4 business days for PT and 15 days for PT (p .001) but not significantly different for OT or Rehabilitation Medicine. When adjusting for urban and multidisciplinary status, the wait at clinics accepting public insurance was 59% longer for PT (95% CI 39-81%), 18% longer for OT (95% CI 7-30%) and 107% longer for ST (95% CI 87-130%) than at clinics accepting only private insurance. Conclusions: There are insurance-based disparities in access to outpatient rehabilitation services. Therapy clinics offering services for children with TBI were less likely to offer appointments for callers with public versus private insurance. Therapy clinics accepting public insurance had longer wait times than clinics that accepted only private insurance. Key Words: Health Services Accessibility, Rehabilitation Centers, Healthcare Disparities, Disabled Children Disclosures: None disclosed. Research Poster 813 Chemotherapy for Cancer and the Aging Brain: Blessing or Burden? Ruth Morin (Teachers College, Columbia University), Elizabeth Midlarsky Research Objectives: To investigate whether treatment of cancer with chemotherapy, when compared to treatment with surgery or radiation, differentially affects cognitive functioning among older adults. Design: Data were examined prospectively from two years prior to cancer diagnosis to four years after cancer diagnosis, and into remission. Distinct classes of cognitive functioning were identified using latent class growth analysis techniques (LCGA). Treatment type was then assessed as a predictor of class membership. Setting: Data were collected from a large population-based cohort in the context of the Health and Retirement Study. Participants: 403 older adults with a new diagnosis of cancer, who were still alive 4 years after their diagnosis. Participants had provided informed consent for the data collection, and the use of the data was approved by the Institutional Review Board of Columbia University, Teachers College. Interventions: Not applicable. Main Outcome Measure(s): Cognition (degree of immediate recall and delayed recall of a word list). Results: Findings indicated that three classes of cognitive functioning best fit the data, including a high recall class, middle recall class, and a low recall class. When treatment type was entered into the model as a covariate, neither treatment with surgery nor radiation significantly predicted membership in any of the three class of cognitive functioning. Individuals treated with chemotherapy, however, were significantly more likely to be in the high recall class than either the middle recall or low recall classes. Conclusions: Three distinct classes of cognitive functioning emerged among older adults with cancer. Treatment with chemotherapy predicted likely membership in the high recall class in this sample of cancer survivors, with implications for understanding cognitive sequelae of cancer in late life. Key Words: Aging, Cancer, Cognition, Chemotherapy Disclosures: None disclosed.
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e135 Design: Audit study using paired telephone calls by callers posing as mother of a child with history of severe TBI seeking outpatient rehabilitation services. Setting: Outpatient rehabilitation service clinics in Washington State. Participants: 195 Physical Therapy (PT), 109 Occupational Therapy (OT), 102 Speech Therapy (ST) and 11 Rehabilitation Medicine clinics. Interventions: Not applicable. Main Outcome Measure(s): Offer of appointment at clinic and wait time in work days until the next available appointment. Results: Therapy clinics were more likely to accept private versus public insurance (relative risk (RR) for PT 1.33 (95% confidence interval (CI) 1.22-1.44), for OT 1.40 (95% CI 1.24-1.57), and for ST 1.42 (95% CI 1.251.62)), but there was no significant difference for Rehabilitation Medicine clinics (RR 1.10, 95% CI 0.90-1.34). The difference in median wait time between clinics that accepted public versus only private insurance was 4 business days for PT and 15 days for PT (p .001) but not significantly different for OT or Rehabilitation Medicine. When adjusting for urban and multidisciplinary status, the wait at clinics accepting public insurance was 59% longer for PT (95% CI 39-81%), 18% longer for OT (95% CI 7-30%) and 107% longer for ST (95% CI 87-130%) than at clinics accepting only private insurance. Conclusions: There are insurance-based disparities in access to outpatient rehabilitation services. Therapy clinics offering services for children with TBI were less likely to offer appointments for callers with public versus private insurance. Therapy clinics accepting public insurance had longer wait times than clinics that accepted only private insurance. Key Words: Health Services Accessibility, Rehabilitation Centers, Healthcare Disparities, Disabled Children Disclosures: None disclosed. Research Poster 813 Chemotherapy for Cancer and the Aging Brain: Blessing or Burden? Ruth Morin (Teachers College, Columbia University), Elizabeth Midlarsky Research Objectives: To investigate whether treatment of cancer with chemotherapy, when compared to treatment with surgery or radiation, differentially affects cognitive functioning among older adults. Design: Data were examined prospectively from two years prior to cancer diagnosis to four years after cancer diagnosis, and into remission. Distinct classes of cognitive functioning were identified using latent class growth analysis techniques (LCGA). Treatment type was then assessed as a predictor of class membership. Setting: Data were collected from a large population-based cohort in the context of the Health and Retirement Study. Participants: 403 older adults with a new diagnosis of cancer, who were still alive 4 years after their diagnosis. Participants had provided informed consent for the data collection, and the use of the data was approved by the Institutional Review Board of Columbia University, Teachers College. Interventions: Not applicable. Main Outcome Measure(s): Cognition (degree of immediate recall and delayed recall of a word list). Results: Findings indicated that three classes of cognitive functioning best fit the data, including a high recall class, middle recall class, and a low recall class. When treatment type was entered into the model as a covariate, neither treatment with surgery nor radiation significantly predicted membership in any of the three class of cognitive functioning. Individuals treated with chemotherapy, however, were significantly more likely to be in the high recall class than either the middle recall or low recall classes. Conclusions: Three distinct classes of cognitive functioning emerged among older adults with cancer. Treatment with chemotherapy predicted likely membership in the high recall class in this sample of cancer survivors, with implications for understanding cognitive sequelae of cancer in late life. Key Words: Aging, Cancer, Cognition, Chemotherapy Disclosures: None disclosed.