COVID-19 Commons^™

Combating Disparities In A Pandemic: Increasing Dissemination Of Coronavirus Disease 2019 Resources In Spanish., Romina Barral, Nicholas Clark, Fernando Zapata, Lines Vargas Collado, July Jean Cuevas, Cristina Fernandez Md

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Disparities exist in access to coronavirus disease 2019 (COVID-19)-related health information. We aimed to close a gap in online traffic between English and Spanish COVID-19-related health information on our institution's publicly-facing website by 50% within ten months.

METHODS: We used A3 improvement methodology. Outcome measures were the mean monthly difference between English and Spanish COVID-19 online traffic vis-a-vis (1) total webpage views and (2) unique webpage visits. Process measures were stratification of outcome measures by language. Plan-Do-Study-Act cycles included: Recurring advertisements on a local Spanish television station disseminating up-to-date COVID-19 information, including our institution's Spanish COVID-19 online resources, incorporation …

Covid-19 Vaccine Confidence, Concerns, And Uptake In Children Aged 5 And Older In Calgary, Alberta: A Longitudinal Cohort Study, Emily J Doucette, Leah Ricketson, Tarannum Tarannum, Isabella Alatorre, Joslyn Gray, Cora Constantinescu, Susan Kuhn, Jessica K E Dunn, James D Kellner

Student and Faculty Publications

OBJECTIVES: Beginning early in the pandemic, there was a worldwide effort to develop effective vaccines against the SARS-CoV-2 virus. Before and after the approval and implementation of vaccines, there were concerns about their need as well as their safety and rapid development. We explored child demographic characteristics and parental concerns to identify factors associated with the decision to vaccinate.

METHODS: A cohort of 1035 children from Calgary was assembled in 2020 to participate in 5 visits every 6 months for survey completion and blood sampling for SARS-CoV-2 antibodies. Visits 1 to 2 occurred before approval of vaccines for children; Visits …

Researching Covid To Enhance Recovery (Recover) Pediatric Study Protocol: Rationale, Objectives And Design, Rachel S. Gross, Tanayott Thaweethai, Erika B. Rosenzweig, James Chan, Lori B. Chibnik, Mine S. Cicek, Amy J. Elliott, Valerie J. Flaherman, Andrea S. Foulkes, Margot Gage Witvliet, Richard Gallagher, Maria Laura Gennaro, Terry L. Jernigan, Elizabeth W. Karlson, Stuart D. Katz, Patricia A. Kinser, Lawrence C. Kleinman, Michelle F. Lamendola-Essel, Joshua D. Milner, Sindhu Mohandas, Praveen C. Mudumbi, Jane W. Newburger, Kyung E. Rhee, Amy L. Salisbury, Jessica N. Snowden, Cheryl R. Stein, Melissa S. Stockwell, Kelan G. Tantisira, Tamara Bradford, Et Al

School of Medicine Faculty Publications

Importance The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or “Long COVID”) in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. Observations We describe the protocol for the Pediatric Observational Cohort Study of the NIH’s REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of …

Parent-Reported Provider Recommendation Of Hpv Vaccination Among Minority Adolescents Before And During The Covid-19 Pandemic: Findings From The National Immunization Survey-Teen, 2019-2021, Chinenye Lynette Ejezie, Paula Cuccaro, Casey Durand, Lara Savas, Ross Shegog

Student and Faculty Publications

Provider recommendation of human papillomavirus (HPV) vaccination among adolescents has steadily improved over the years, however, limited research has been conducted to examine if the COVID-19 pandemic disrupted this positive trend in parent-reported provider recommendation among minority adolescents. Therefore, we conducted the present study to determine if there is an association between the pandemic and parent-reported provider recommendation of HPV vaccine among non-Hispanic black and Hispanic adolescents. We also examined whether any changes in parent-reported provider recommendation in the years 2019, 2020, and 2021 differed by race or ethnicity. Using a cross-sectional design to examine data from the National Immunization …

Pediatric Firearm Injury Epidemiology At A Level 1 Trauma Center From 2019 To 2021: Including Time Of The Covid-19 Pandemic, Cynthia Orantes, Hei Kit Chan, Daniel Walter, Summer Chavez, Irma T Ugalde

Student and Faculty Publications

BACKGROUND: Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic.

RESULTS: The total number of pediatric firearm-related injury cases increased during March 15th to December 31st, 2020 and 2021 compared to the same time period in 2019 (104 verses 89 verses 78). The demographic group most affected across years …

Postoperative Respiratory Complications In Sars-Cov-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study, Audra J Reiter, Martha-Conley E Ingram, Mehul V Raval, Elisa Garcia, Madelyn Hill, Arturo Aranda, Nicole M Chandler, Raquel Gonzalez, Kristen Born, Shale Mack, Abdulraouf Lamoshi, Aaron M Lipskar, Xiao-Yue Han, Elizabeth Fialkowski, Brianna Spencer, Afif N Kulaylat, Amrene Barde, Ami N Shah, Maeva Adoumie, Erica Gross, Steven C Mehl, Monica E Lopez, Valerie Polcz, Moiz M Mustafa, Jeffrey W Gander, Travis M Sullivan, Jason P Sulkowski, Owais Ghani, Eunice Y Huang, David Rothstein, E Peter Muenks, Shawn D St Peter, Jason C Fisher, Dina Levy-Lambert, Allison Reichl, Romeo C Ignacio, Bethany J Slater, Kuojen Tsao, Loren Berman

Student and Faculty Publications

INTRODUCTION: Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.

METHODS: This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics …

Management Of Pediatric Appendicitis During The Covid-19 Pandemic: A Nationwide Multicenter Cohort Study, Brittany Hegde, Elisa Garcia, Andrew Hu, Mehul Raval, Sanyu Takirambudde, Derek Wakeman, Ruth Lewit, Ankush Gosain, Raphael H Parrado, Robert A Cina, Krista Stephenson, Melvin S Dassinger, Daniel Zhang, Moiz M Mustafa, Donna Koo, Aaron M Lipskar, Katherine Scheidler, Kyle J Van Arendonk, Patrick Berg, Raquel Gonzalez, Daniel Scheese, Jeffrey Haynes, Alexander Mina, Irving J Zamora, Monica E Lopez, Steven C Mehl, Elizabeth Gilliam, Katrina Lofberg, Brianna Spencer, Afif N Kulaylat, Brian C Gulack, Matthew Johnson, Matthew Laskovy, Pavan Brahmamdam, Aoi Shimomura, Therese Blanch, Kuojen Tsao, Bethany J Slater

Student and Faculty Publications

BACKGROUND: The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes.

METHODS: A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed.

RESULTS: Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More …

Sars-Cov-2 Serostatus And Covid-19 Illness Characteristics By Variant Time Period In Non-Hospitalized Children And Adolescents, Sarah E Messiah, Michael D Swartz, Rhiana A Abbas, Yashar Talebi, Harold W Kohl, Melissa Valerio-Shewmaker, Stacia M Desantis, Ashraf Yaseen, Steven H Kelder, Jessica A Ross, Lindsay N Padilla, Michael O Gonzalez, Leqing Wu, David Lakey, Jennifer A Shuford, Stephen J Pont, Eric Boerwinkle

Student and Faculty Publications

OBJECTIVE: to describe COVID-19 illness characteristics, risk factors, and SARS-CoV-2 serostatus by variant time period in a large community-based pediatric sample.

DESIGN: Data were collected prospectively over four timepoints between October 2020 and November 2022 from a population-based cohort ages 5 to 19 years old.

SETTING: State of Texas, USA.

PARTICIPANTS: Participants ages 5 to 19 years were recruited from large pediatric healthcare systems, Federally Qualified Healthcare Centers, urban and rural clinical practices, health insurance providers, and a social media campaign.

EXPOSURE: SARS-CoV-2 infection.

MAIN OUTCOME(S) AND MEASURE(S): SARS-CoV-2 antibody status was assessed by the Roche Elecsys

RESULTS: Over half …

How Have Researchers Defined Institutions, Politics, Organizations And Governance In Research Related To Epidemic And Pandemic Response? A Scoping Review To Map Current Concepts, Austin Wu, Shivangi Khanna, Shelly Keidar, Peter Berman, Laura Jane Brubacher

Student and Faculty Publications

In recent years, the literature on public health interventions and health outcomes in the context of epidemic and pandemic response has grown immensely. However, relatively few of these studies have situated their findings within the institutional, political, organizational and governmental (IPOG) context in which interventions and outcomes exist. This conceptual mapping scoping study synthesized the published literature on the impact of IPOG factors on epidemic and pandemic response and critically examined definitions and uses of the terms IPOG in this literature. This research involved a comprehensive search of four databases across the social, health and biomedical sciences as well as …

Containment Measures During The Covid Pandemic: The Role Of Non-Pharmaceutical Health Policies, Michael Funke, Tai-Kuang Ho, Andrew Tsang

Student and Faculty Publications

Many countries have imposed a set of non-pharmaceutical health policy interventions in an effort to slow the spread of the COVID-19 pandemic. The objective of this paper is to examine the effects of the interventions, drawing on evidence from the OECD countries. A special feature here is the mechanism that underlies the impact of the containment policies. To this end, a causal mediation analysis decomposing the total effect into a direct and an indirect effect is conducted. The key finding is a dual cause-effect channel. On the one hand, there is a direct effect of the non-pharmaceutical interventions on the …

A Review Of The Effectiveness, Feasibility, And Acceptability Of Art Therapy For Children And Adolescents During The Covid-19 Pandemic, Minh Ngoc Le Vu, Anh Linh Do, Laurent Boyer, Quy Chi Tran, Stefan Kohler, Syed Ishtiaque Ahmed, Andreea Molnar, Tung Son Vu, Nhan Trong Huynh Vo, Linh Mai Vu Nguyen, Linh Gia Vu, Vu Anh Trong Dam, Thomy Duong, Dan Linh Nguyen Do, Ngoc Minh Do, Roger S Mclntyre, Carl Latkin, Roger Chun Man Ho, Cyrus Su Hui Ho

Faculty and Staff Publications

Art therapy has been widely offered to reduce symptoms of psychological disturbance. Pooled evidence about its effectiveness in epidemic contexts, particularly during the COVID-19 pandemic, has not been yet established. This study reviewed the effectiveness, feasibility, and acceptability of art therapy on children and adolescents during the COVID-19 pandemic and past epidemics. We searched PubMed/Medline, PsycINFO, CENTRAL (Cochrane Library), and CINAHL for articles on art therapy during COVID-19. Included studies reported improvements in measures of mental health, sleep quality, and psychological well-being in children with or without disabilities in the epidemic context. Results also showed that art therapy was highly …

Effectiveness And Adherence To Closed Face Shields In The Prevention Of Covid-19 Transmission: A Non-Inferiority Randomized Controlled Trial In A Middle-Income Setting (Covproshield), Andrea Ramirez Varela, Alejandro Pacheco Gurruchaga, Silvia Restrepo Restrepo, Juan David Martin, Yessica Daniela Campaz Landazabal, Guillermo Tamayo-Cabeza, Sandra Contreras-Arrieta, Yuldor Caballero-Díaz, Luis Jorge Hernandez Florez, John Mario González, Juan Carlos Santos-Barbosa, José David Pinzón, Juan José Yepes-Nuñez, Rachid Laajaj, Giancarlo Buitrago Gutierrez, Martha Vives Florez, Janner Fuentes Castillo, Gianni Quinche Vargas, Andres Casas, Antonio Medina, Eduardo Behrentz, Covida Working Group

Student and Faculty Publications

BACKGROUND: The use of respiratory devices can mitigate the spread of diseases such as COVID-19 in community settings. We aimed to determine the effectiveness of closed face shields with surgical face masks to prevent SARS-CoV-2 transmission in working adults during the COVID-19 pandemic in Bogotá, Colombia.

METHODS: An open-label non-inferiority randomized controlled trial that randomly assigned participants to one of two groups: the intervention group was instructed to wear closed face shields with surgical face masks, and the active control group was instructed to wear only surgical face masks. The primary outcome was a positive reverse transcription polymerase chain reaction …

International Prevalence And Mechanisms Of Sars-Cov-2 In Childhood Arterial Ischemic Stroke During The Covid-19 Pandemic, Lauren A Beslow, Shannon C Agner, Jonathan D Santoro, Dipak Ram, Jenny L Wilson, Dana Harrar, Brian Appavu, Stuart M Fraser, Thomas Rossor, Marcela D Torres, Manoëlle Kossorotoff, Yenny C Zuñiga Zambrano, Marta Hernández-Chávez, Sahar M A Hassanein, Dimitrios Zafeiriou, Michael M Dowling, Ilona Kopyta, Nicholas V Stence, Timothy J Bernard, Nomazulu Dlamini

Student and Faculty Publications

BACKGROUND: Data from the early pandemic revealed that 0.62% of children hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had an acute arterial ischemic stroke (AIS). In a larger cohort from June 2020 to December 2020, we sought to determine whether our initial point estimate was stable as the pandemic continued and to understand radiographic and laboratory data that may clarify mechanisms of pediatric AIS in the setting of SARS-CoV-2.

METHODS: We surveyed international sites with pediatric stroke expertise to determine numbers of hospitalized SARS-CoV-2 patients <18 >years, numbers of incident AIS cases among children (29 days to <18 >years), frequency …

Telehealth Diagnosis Of Autism Spectrum Disorder Through Clinical Cases, Natasha N Ludwig, Amanda E Child, Dasal Tenzin Jashar, Allison J Mostow, Ericka L Wodka

Student and Faculty Publications

A diagnosis of autism spectrum disorder (ASD) provides access to interventions that are important for fostering development and improving quality of life. Thus, the timeliness of a diagnosis should not be limited by social-distancing limitations whenever possible. Despite this, clear guidance for transitioning autism diagnostic services to a telehealth model of care in the era of the COVID-19 pandemic is lacking. At our Institute, we have adapted our approach to ASD evaluation to promote continued access to evaluation services during this unprecedented time. The purpose of this case series is to provide examples of three different approaches to ASD differential …

Case Report: Successful Treatment Of A Child With Covid-19 Reinfection-Induced Fulminant Myocarditis By Cytokine-Adsorbing Oxiris® Hemofilter Continuous Veno-Venous Hemofiltration And Extracorporeal Membrane Oxygenation, Phuc H Phan, Dung T Nguyen, Nam H Dao, Ha T T Nguyen, An V Vu, Son T Hoang, Lam V Nguyen, Tung V Cao, Dien M Tran

Student and Faculty Publications

BACKGROUND: Indirect cardiomyocyte damage-related hyperinflammatory response is one of the key mechanisms in COVID-19-induced fulminant myocarditis. In addition to the clinical benefit of using cytokines absorption hemofiltration, the effectiveness of instituting veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for cardiac compromise has been reported. However, current literature enunciates a paucity of available data on the effectiveness of these novel modalities.

CASE PRESENTATION: We reported a 9-year-old boy with recurrent COVID-19 infection-causing fulminant myocarditis, who was treated successfully by using novel modalities of

CONCLUSION: We conclude that the novel highly-absorptive hemofilter CVVH and VA-ECMO may be effective treatment modalities in managing SARS-CoV-2-induced …

Mrna Coronavirus Disease 2019 Vaccine-Associated Myopericarditis In Adolescents: A Survey Study, Utkarsh Kohli, Lavina Desai, Devyani Chowdhury, Ashraf S Harahsheh, Alexandra B Yonts, Annette Ansong, Arash Sabati, Hoang H Nguyen, Tarique Hussain, Danyal Khan, David A Parra, Jennifer A Su, Jyoti K Patel, Christina Ronai, Monique Bohun, Bishara J Freij, Matthew J O'Connor, Joseph W Rosanno, Aamisha Gupta, Arash Salavitabar, Adam L Dorfman, Jesse Hansen, Olivia Frosch, Elizabeth L Profita, Shiraz Maskatia, Deepika Thacker, Shubhika Shrivastava, Tyler H Harris, Brian Feingold, Stuart Berger, Michael Campbell, Salim F Idriss, Srikant Das, Markus S Renno, Ken Knecht, S Yukiko Asaki, Sunil Patel, Ravi Ashwath, Renata Shih, John Phillips, Bibhuti Das, Preeti Ramachandran, Eyal Sagiv, Aarti H Bhat, Jonathan N Johnson, Nathaniel W Taggart, Jason Imundo, Natasha Nakra, Shashank Behere, Anjlee Patel, Avichal Aggarwal, Saif Aljemmali, Sean Lang, Sarosh P Batlivala, Daniel E Forsha, Gregory P Conners, Jana Shaw, Frank C Smith, Linda Pauliks, Joseph Vettukattil, Kenneth Shaffer, Stefanie Cheang, Sonia Voleti, Rajesh Shenoy, Rukmini Komarlu, Shea J Ryan, Christopher Snyder, Neha Bansal, Madhu Sharma, Jeffrey A Robinson, Sandra R Arnold, Christine M Salvatore, Madan Kumar, Michael A Fremed, Julie S Glickstein, Melissa Perrotta, William Orr, Tamika Rozema, Muthayipalayam Thirumoorthi, Charles J Mullett, Jocelyn Y Ang

Student and Faculty Publications

In this survey study of institutions across the US, marked variability in evaluation, treatment, and follow-up of adolescents 12 through 18 years of age with mRNA coronavirus disease 2019 (COVID-19) vaccine-associated myopericarditis was noted. Only one adolescent with life-threatening complications was reported, with no deaths at any of the participating institutions.

Covid-19 In Children And The Influence On The Employment Activity Of Their Female Caregivers: A Cross Sectional Gender Perspective Study, Catalina Jaime Trujillo, Natalia Herrera Olano, Kevin Rico Gutiérrez, Daniela Medellín, Paola Sánchez, María Lucía Mesa-Rubio, Melisa Sofía Naranjo, Sergio Mauricio Moreno, Carolina Bonilla, Pedro Barrera, Sonia M Restrepo-Gualteros, Luz Marina Mejia, Olga Lucía Baquero, Juan Gabriel Piñeros, Andrea Ramírez Varela

Student and Faculty Publications

INTRODUCTION: During the COVID-19 pandemic, women disproportionately assume more unpaid activities, affecting their employment.

OBJECTIVE: Describe the influence of COVID-19 on the employment of caregivers of children and adolescents from a gender perspective.

METHODS: Cross-sectional study in three high-complexity hospitals in Bogotá, Colombia from April 2020 to June 2021. A subsample of the FARA cohort was taken, including those patients with a positive test for SARS-COV2. We took as our analysis category children older than 8 years and younger than 18 years who had a positive SARS-COV2 test, as well as, caregivers of all children with a positive SARS-COV2 test. …

Coping With Adverse Childhood Experiences During The Covid-19 Pandemic: Perceptions Of Mental Health Service Providers, Sumaita Choudhury, Paul G Yeh, Christine M Markham

Student and Faculty Publications

BACKGROUND: Adverse Childhood Experiences (ACEs) have been associated with long-term physical and mental health conditions, toxic stress levels, developing unstable interpersonal relationships, and substance use disorders due to unresolved childhood adversities.

AIMS: This study assessed the perspectives of mental health providers (MHPs) regarding their adult patients' coping with ACEs during COVID-19 in Houston, Texas. Specifically, we explored how individuals with ACEs are coping with the increased stresses of the pandemic, how MHPs may provide therapeutic support for individuals with ACEs during this pandemic, pandemic-related challenges of accessing and utilizing mental health services for individuals with ACEs, and the awareness and …

Cerebral Infarctions In An Infant With Covid-19 Delta Variant Infection And Disseminated Tuberculosis, Stuart Fraser, Misti Ellsworth, Norma Perez, Hunter Hamilton, Stephen Fletcher, Deborah Brown, Lakshmi Srivaths

Student and Faculty Publications

No abstract provided.

Use Of Modeling To Inform Decision Making In North Carolina During The Covid-19 Pandemic: A Qualitative Study, Karl Johnson, Caitlin B Biddell, Kristen Hassmiller Lich, Julie Swann, Paul Delamater, Maria Mayorga, Julie Ivy, Raymond L Smith, Mehul D Patel

Student and Faculty Publications

Background. The COVID-19 pandemic has popularized computer-based decision-support models, which are commonly used to inform decision making amidst complexity. Understanding what organizational decision makers prefer from these models is needed to inform model development during this and future crises. Methods. We recruited and interviewed decision makers from North Carolina across 9 sectors to understand organizational decision-making processes during the first year of the COVID-19 pandemic (N = 44). For this study, we identified and analyzed a subset of responses from interviewees (n = 19) who reported using modeling to inform decision making. We used conventional content analysis to …

Invasive Haemophilus Influenza Type B In An Infant During The Covid-19 Pandemic: The Return Of Diseases We Hoped Never To See Again…., Christy Tabarani, Stephen A Fletcher, Gloria P Heresi, Susan H Wootton

Student and Faculty Publications

No abstract provided.

Prevalence Of Functional Limitation In Covid-19 Recovered Patients Using The Post Covid-19 Functional Status Scale, Pankaj Pant, Aishana Joshi, Babin Basnet, Bibek Man Shrestha, Navindra Raj Bista, Niraj Bam, Santa Kumar Das

Student and Faculty Publications

INTRODUCTION: COVID-19 is an emerging global health pandemic causing tremendous morbidity and mortality worldwide. Chronic symptoms progressing to poor functional status have been reported in a substantial proportion of COVID-19 patients worldwide. This study aimed to determine the prevalence of functional limitation in COVID-19 recovered patients using the post-COVID-19 functional status scale.

METHODS: A descriptive cross-sectional study was conducted at Tribhuvan University Teaching Hospital. COVID-19 recovered patients with reverse transcription-polymerase chain reaction negative status were included and assessed using the post-COVID-19 functional status scale. Data entry and analysis was done in Statistical Package for the Social Sciences version 20.0. Descriptive …

“Doing What I Can, But I Got No Magic Wand:” A Snapshot Of Early Childhood Educator Experiences And Efforts To Ensure Quality During The Covid-19 Pandemic, April Crawford, Kelly A Vaughn, Cathy L Guttentag, Cheryl Varghese, Yoonkyung Oh, Tricia A Zucker

Student and Faculty Publications

The COVID-19 pandemic impacted early childhood programs serving infants, toddlers, and preschoolers in dramatic ways. After temporarily closing, many educators quickly adapted their procedures to ensure children's safety as they reopened to provide childcare for essential workers and then the community at large. This manuscript reports on statewide efforts to continue quality improvement initiatives for early childhood programs amidst the COVID-19 pandemic. We first describe the impacts of the COVID-19 pandemic for over 2000 educators-teachers, administrators, and specialists-who completed surveys in the Spring and Fall of 2020. These survey data come from a statewide system called the Texas Early Childhood …