Despite a critical need for long-term follow-up care, only one-third of childhood cancer survivors (CCS) report receiving survivor-focused care, and even fewer receive risk-reduction counseling and appropriate screening. Numerous studies have described barriers experienced by CCS at the individual level, which largely stem from socioeconomic factors. As a result, at-risk populations have limited opportunities to engage in long-term follow- up care, placing them at higher risk for treatment-related morbidities. Few studies have successfully tested effective, sustainable interventions to overcome structural barriers within the cancer center environment, factors that contribute to CCS outcome disparities by limiting access to survivorship care. Equitable access to quality survivorship care cannot be achieved without addressing existing barriers to health care utilization. The objective of our proposal is to evaluate hospital policies and procedures that disproportionately impact CCS from disadvantaged backgrounds, and identify novel strategies that eliminate, circumvent, or overcome systematic barriers to CCS entry into long-term follow-up care. Aim 1 will leverage electronic health record data extraction tools to abstract relevant sociodemographic data from living CCS that have completed treatment. We will then develop an algorithm for identifying CCS at-risk for suboptimal health care utilization (defined as failure to enter long-term follow-up care by four years after completing treatment). To do this, we will use factors predictive of survivorship nonadherence from our previously published work, and incorporate area-based measures of socioeconomic deprivation. For Aim 2 we will prospectively identify CCS who are at-risk for suboptimal health care utilization and eligible for entry to long-term follow-up (at least 3 years from end of therapy) who have not yet scheduled a visit in the Long Term Survivor (LTS) Clinic. A Survivorship Navigator will contact at-risk CCS to complete a survey that assesses structural barriers, data that will be used to inform development of an LTS Resource Tool Kit. For Aim 3, the Survivorship Navigator will use the LTS Resource Tool Kit to offer at-risk CCS personalized solutions to the barriers they endorsed in Aim 2. Clinical benefit to the intervention will be assessed by comparing the rates of first LTS visit per eligible at-risk CCS to rates from historical at-risk CCS controls. The impact of the intervention on cost efficacy will be determined from the personnel time spent in navigation activities plus Tool Kit-related expenses to the resulting increase in revenue generated from LTS visits. We anticipate this project will improve the proportion of eligible at-risk CCS that initiate long-term follow-up care in the LTS Clinic. Evidence generated by the results of this study will provide practical, sustainable, and, most importantly, generalizable solutions that maximize survivorship care uptake in at-risk CCS. Futu...