1
|
Candelaria MA, Tellerman K, Hutchison H, Silver D, Feigelman S, Endy K, Afkinich J, Wilms Floet AM. The TREE Program: Promoting Positive Early Childhood Experiences During Well-Child Visits. Clin Pediatr (Phila) 2024:99228241258526. [PMID: 38853704 DOI: 10.1177/00099228241258526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
This feasibility study evaluated the developmental coaching TREE (Talk Read Engage Encourage) program for historically marginalized children ages 0 to 2 years, embedded within pediatric visits, examining if TREE could enhance caregiver-child interactions and increase pediatric resident report of competency and self-efficacy in coaching caregivers. Using a quasi-experimental design, a convenience sample (n = 167 families) was recruited (79 intervention; 88 control). Follow-up data were obtained from 45% of families (38 intervention; 38 control), impacted by COVID-19 attendance. Analyses demonstrated significant increases in self-reported Parent Verbal Responsivity (d = 0.68; 95% confidence interval [CI] = 0.17 to 1.18; P = .009) by intervention group caregivers. Intervention pediatric residents reported significant increases in promoting positive caregiver-child interactions and confidence in conveying child development (d = -.73; 95% CI = -1.21 to -0.22; P = .003). The TREE program is a promising practice that operationalizes promotion of relational health and positive early childhood experiences within pediatric primary care.
Collapse
Affiliation(s)
- Margo A Candelaria
- Innovations Institute, University of Connecticut School of Social Work, Hartford, CT, USA
| | - Ken Tellerman
- Committee on Emotional Health, Maryland Chapter, American Academy of Pediatrics, Baltimore, MD, USA
| | - Heather Hutchison
- Innovations Institute, University of Connecticut School of Social Work, Hartford, CT, USA
| | | | - Susan Feigelman
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katherine Endy
- Women's Institute of Torah Seminary & College, Baltimore, MD, USA
| | - Jenny Afkinich
- Collaborative for Implementation Practice, School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna Maria Wilms Floet
- Department of Pediatrics, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
2
|
Dever R, Wong CA, Franklin MS, Howard J, Cholera R. Caregiver Perspectives on Barriers and Facilitators to Timely Well-Child Visits for Black Infants. Matern Child Health J 2024; 28:915-925. [PMID: 38300471 DOI: 10.1007/s10995-023-03871-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Missed infant well-child visits (WCV) result in lost opportunities for critical preventive care. Black infants consistently receive less WCV care than other racial groups. We sought to understand barriers and facilitators to timely infant WCV for Black families in the context of COVID-19. METHODS We conducted 21 semi-structured interviews with caregivers of Medicaid-insured Black children aged 15- to 24-months who attended six or fewer of eight recommended well-child visits within the first 15 months of life. Interviews focused on WCV value, barriers, and facilitators. After developing our initial coding structure through rapid qualitative analysis, we inductively derived the final codebook and themes through line-by-line content analysis. RESULTS Caregivers attended a mean of 3.53 of eight infant visits. Structural (e.g., transportation) and psychological (e.g., maternal depression) barriers delayed Black infant WCV. Families most frequently valued monitoring development and addressing concerns. Caregivers perceived visits as less urgent when infants seemed healthy or more recently avoided visits due to fears around COVID-19. Long waits and feeling rushed/dismissed were linked to WCV delays; positive provider relationships encouraged WCV attendance. Most caregivers reported reluctance to vaccinate. Vaccine hesitancy contributed to delayed infant WCV. CONCLUSIONS Caregivers described several factors that impacted WCV attendance for Black infants. Persistent structural and psychological barriers are compounded by perceptions that caregiver time is not respected and by notable vaccine hesitancy. To address these barriers, well-care can meet Black families in their communities, better address caregiver wellbeing, more efficiently use caregiver and provider time, and cultivate partnerships with Black caregivers.
Collapse
Affiliation(s)
- Reilly Dever
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Charlene A Wong
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michelle S Franklin
- Duke Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
- Department of Psychiatry, Duke University, 2301 Erwin Rd, Durham, NC, 27707, USA
| | - Janna Howard
- Duke Center for Childhood Obesity Research, 3116 N. Duke Street, Room 1028, Durham, NC, 27704, USA
| | - Rushina Cholera
- Duke Margolis Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC, 27708, USA
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC, 27710, USA
- Department of Pediatrics, Duke University, 2301 Erwin Rd, Durham, NC, 27707, USA
- Department of Population Health Sciences, Duke University, 215 Morris St, Durham, NC, 27701, USA
| |
Collapse
|
3
|
Grant AR, Cockburn B, Ahmed F, Dumanian R, Garcia Y, Gould J, Martinez-Novoa F, McFarland M, Dawson-Hahn E. Caregiver Experience with Bicultural, Bilingual Family Navigators to Support Early Childhood Development. J Immigr Minor Health 2024:10.1007/s10903-024-01591-9. [PMID: 38587688 DOI: 10.1007/s10903-024-01591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/09/2024]
Abstract
Recognizing the inequities in developmental screening and services for children in immigrant families, a pediatric primary care clinic in partnership with a community-based early childhood program co-created a bicultural, bilingual early childhood developmental (ECD) family navigator program in Seattle, Washington. The primary aim of this study is to explore caregivers' perspectives about this program. Twenty-seven caregivers of young children participated in semi-structured interviews that were thematically analyzed. Three key themes were identified: 1) sharing language and culture, 2) facilitating accessibility, and 3) promoting development. Caregivers valued linguistic and cultural concordance between the navigator and the family, the navigator's approach to screening to improve accessibility and reduce barriers, and the focus on supporting early childhood development. Understanding caregivers' experience with the ECD family navigator development program and the aspects they value, informs clinic-based approaches to ensure families of diverse language and cultural backgrounds have accessible development screening and connection to services.
Collapse
Affiliation(s)
- Abigail R Grant
- Department of Pediatrics, University of Washington, 325 Ninth Ave, Seattle, WA, 98104, USA.
- Harborview Medical Center, Seattle, WA, USA.
| | - Brenna Cockburn
- School of Medicine, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | | | - Elizabeth Dawson-Hahn
- Department of Pediatrics, University of Washington, 325 Ninth Ave, Seattle, WA, 98104, USA
- Harborview Medical Center, Seattle, WA, USA
| |
Collapse
|
4
|
Smith BM, Patel PP, Johnson SB, Bethell C. Racial and Ethnic Disparities in the Medical Home for Children Born Premature in the National Survey of Children's Health. Acad Pediatr 2023; 23:1579-1587. [PMID: 37524165 DOI: 10.1016/j.acap.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Children born premature are more likely to be from minoritized racial and ethnic groups and face chronic health and developmental problems. The medical home aims to comprehensively address health and social needs of all families. This study evaluates racial and ethnic disparities in the prevalence of a medical home among children born premature compared to children born full-term. METHODS A 2017-18 National Survey of Children's Health data set was used to calculate the medical home performance measure and subcomponents for children aged 0 to 17 born premature (n = 5633) or full-term (n = 45,819). Chi square and logistic regression assessed magnitude and significance of variations by race and ethnicity and prematurity status. RESULTS Prematurity prevalence differed by race and ethnicity (12.0% non-Hispanic Black [NHB], 12.8% Hispanic, 11.1% Multiracial/Other, 11.0% non-Hispanic White [NHW]). Minoritized children born premature had lower adjusted odds of receiving care in a medical home compared to NHW peers (eg, NHB adjusted odds ratio [aOR] 0.54 [95% confidence interval {CI}: 0.38-0.76] and Hispanic aOR 0.56 [95% CI: 0.40-0.79]). Differences were greater in magnitude among children born premature compared to full-term peers (eg, NHB premature aOR 0.54 [95% CI: 0.38-0.76] vs NHB full-term aOR 0.67 [95% CI: 0.58-0.78]), with similar results for "personal doctor/nurse" and "usual sick care." CONCLUSIONS Racial and ethnic disparities exist in the medical home among children born premature, some more pronounced than full-term peers. To deliver equitable care for all children, efforts are needed to expand access to and improve the medical home, including reliable routine and sick care and stronger family-provider relationships.
Collapse
Affiliation(s)
- Brandon M Smith
- Department of Pediatrics, Johns Hopkins University School of Medicine (BM Smith), Baltimore, Md.
| | - Palak P Patel
- Johns Hopkins University School of Medicine (PP Patel), Baltimore, Md.
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins University School of Medicine; Departments of Population, Family, and Reproductive Health and Mental Health, Johns Hopkins University Bloomberg School of Public Health (SB Johnson), Baltimore, Md.
| | - Christina Bethell
- Department of Pediatrics, Johns Hopkins University School of Medicine; Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health (C Bethell), Baltimore, Md.
| |
Collapse
|
5
|
Chavez LJ, Tyson DP, Davenport MA, Kelleher KJ, Chisolm DJ. Social Needs as a Risk Factor for Positive Postpartum Depression Screens in Pediatric Primary Care. Acad Pediatr 2023; 23:1411-1416. [PMID: 36958532 DOI: 10.1016/j.acap.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The goal of this study was to examine the association between self-reported social needs and postpartum depression (PPD) symptoms of mothers screened in pediatric primary care clinics. METHODS This retrospective cohort study used electronic health record data from 3616 pediatric patients (age 0-6 months), whose mothers completed the Edinburgh Postpartum Depression Scale (EPDS) and a social needs screening in a large pediatric primary care network between April 2021 and February 2022. Mothers were screened for four self-reported social needs (food, housing, transportation, and utilities). Logistic regression evaluated the association between the report of any social need and a positive EPDS screen (≥ 10), adjusting for demographic and clinical characteristics and ZIP code-level poverty. RESULTS Overall, 8.6% of mothers screened positive for PPD and 10.0% reported any social needs. The odds of a positive depression screen were significantly higher among mothers who reported any social need compared to those not reporting a social need (OR 4.18, 95% CI 3.11-5.61). The prevalence of all depressive symptoms on the EPDS was significantly higher among those who reported any social need, relative to those reporting no needs. Mothers reporting any social needs were significantly more likely to report thoughts of self-harm (6.9% vs 1.5%, P < .005). CONCLUSIONS Self-report of social need was significantly associated with positive PPD screens during infant well-child visits. Social needs may be a target of future interventions addressing PPD in pediatric settings. Improving care for social needs may have added benefit of alleviating the risk of PPD.
Collapse
Affiliation(s)
- Laura J Chavez
- Center for Child Health Equity and Outcomes Research (LJ Chavez, MA Davenport, KJ Kelleher, and DJ Chisolm), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
| | - Danielle P Tyson
- Division of Epidemiology (DP Tyson), College of Public Health, The Ohio State University, Columbus, Ohio.
| | - Mattina A Davenport
- Center for Child Health Equity and Outcomes Research (LJ Chavez, MA Davenport, KJ Kelleher, and DJ Chisolm), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
| | - Kelly J Kelleher
- Center for Child Health Equity and Outcomes Research (LJ Chavez, MA Davenport, KJ Kelleher, and DJ Chisolm), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Division of Health Behavior and Health Promotion (KJ Kelleher), College of Public Health, The Ohio State University, Columbus, Ohio; Department of Pediatrics (KJ Kelleher and DJ Chisolm), College of Medicine, The Ohio State University, Columbus, Ohio.
| | - Deena J Chisolm
- Center for Child Health Equity and Outcomes Research (LJ Chavez, MA Davenport, KJ Kelleher, and DJ Chisolm), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics (KJ Kelleher and DJ Chisolm), College of Medicine, The Ohio State University, Columbus, Ohio.
| |
Collapse
|
6
|
Laster M, Kozman D, Norris KC. Addressing Structural Racism in Pediatric Clinical Practice. Pediatr Clin North Am 2023; 70:725-743. [PMID: 37422311 DOI: 10.1016/j.pcl.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Structural racism is the inequitable allocation of various social determinants of health to different communities. Exposure to this and other discrimination levied from intersectional identities is the primary driver of disproportionately adverse health outcomes for minoritized children and their families. Pediatric clinicians must vigilantly identify and mitigate racism in health care systems and delivery, assess for any impact of patient and family exposure to racism and direct them to appropriate health resources, foster an environment of inclusion and respect, and ensure that all care is delivered through a race-conscious lens with the utmost cultural humility and shared decision-making.
Collapse
Affiliation(s)
- Marciana Laster
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of Pediatric Nephrology, UCLA Department of Pediatrics, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA 90095-1752, USA
| | - Daniel Kozman
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; UCLA Department of Medicine, Section of Medicine-Pediatrics & Preventive Medicine
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, 1100 Glendon Avenue, Suite 710, Los Angeles, CA 90024, USA.
| |
Collapse
|
7
|
Arrojo MJ, Bromberg J, Walter HJ, Vernacchio L. Pediatric Primary-Care Integrated Behavioral Health: A Framework for Reducing Inequities in Behavioral Health Care and Outcomes for Children. Pediatr Clin North Am 2023; 70:775-789. [PMID: 37422314 DOI: 10.1016/j.pcl.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
Nearly half of US children and adolescents will suffer a behavioral health (BH) disorder, with substantially higher rates among more disadvantaged children such as racial/ethnic minorities, LGBTQ + youth, and poor children. The current specialty pediatric BH workforce is inadequate to meet the need and the uneven distribution of specialists as well as other barriers to care, such as insurance coverage and systemic racism/bias, further exacerbate disparities in BH care and outcomes. Integrating BH care into the pediatric primary care medical home has the potential to expand access to BH care and reduce the disparities inherent in the current system.
Collapse
Affiliation(s)
- Maria J Arrojo
- Pediatric Physicians' Organization at Children's, 112 Worcester Street, Suite 300, Wellesley, MA 02481, USA; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Jonas Bromberg
- Pediatric Physicians' Organization at Children's, 112 Worcester Street, Suite 300, Wellesley, MA 02481, USA; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Heather J Walter
- Pediatric Physicians' Organization at Children's, 112 Worcester Street, Suite 300, Wellesley, MA 02481, USA; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Louis Vernacchio
- Pediatric Physicians' Organization at Children's, 112 Worcester Street, Suite 300, Wellesley, MA 02481, USA; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| |
Collapse
|
8
|
Salaguinto T, Guzman Y, Lowry SJ, Liljenquist K, LaFontaine R, Ortiz JE, Szilagyi PG, Fiscella K, Weaver MR, Coker TR. Can a Clinic-Based Community Health Worker Intervention Buffer the Negative Impact of the COVID-19 Pandemic on Health and Well-Being of Low-Income Families during Early Childhood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6407. [PMID: 37510639 PMCID: PMC10379322 DOI: 10.3390/ijerph20146407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
We examined changes in self-reported mental health, physical health, and emotional support among low-income parents with children ages 0-2 years old from pre-pandemic to pandemic periods and compared changes in parental health among parents who did versus did not have access to a clinic-based community health worker intervention supporting parents at early childhood preventive care visits. We utilized longitudinal parent survey data from pre-COVID-19 and COVID-19 time periods from both the intervention and control arms of an existing cohort of parents enrolled in a 10-clinic cluster randomized controlled trial (RCT). At enrollment (pre-pandemic) and 12-month follow-up (pandemic), participants reported on mental health, physical health, and emotional support using PROMIS measures (n = 401). During the pre-pandemic portion, control and intervention group parents had similar mean T-scores for mental health, physical health, and emotional support. At follow-up, mean T-scores for mental health, physical health, and emotional support decreased across both control and intervention groups, but intervention group parents had smaller declines in mental health T-scores (p = 0.005). Our findings indicate that low-income parents with young children suffered significant declines in mental and physical health and emotional support during the pandemic and that the decline in mental health may have been buffered by the community health worker intervention.
Collapse
Affiliation(s)
- Taylor Salaguinto
- Seattle Children’s Research Institute, Seattle Children’s, Seattle, WA 98101, USA
| | - Yasmin Guzman
- Seattle Children’s Research Institute, Seattle Children’s, Seattle, WA 98101, USA
| | - Sarah J. Lowry
- Seattle Children’s Research Institute, Seattle Children’s, Seattle, WA 98101, USA
| | - Kendra Liljenquist
- Seattle Children’s Research Institute, Seattle Children’s, Seattle, WA 98101, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Rachel LaFontaine
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98109, USA
| | - Janette E. Ortiz
- Department of Pediatrics, University of California, Los Angeles, CA 90095, USA
| | - Peter G. Szilagyi
- Department of Pediatrics, University of California, Los Angeles, CA 90095, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, NY 14611, USA
| | - Marcia R. Weaver
- Departments of Health Metrics Sciences & Global Health, University of Washington, Seattle, WA 98121, USA
| | - Tumaini R. Coker
- Seattle Children’s Research Institute, Seattle Children’s, Seattle, WA 98101, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98109, USA
| |
Collapse
|
9
|
Gresh A, Wilson D, Fenick A, Patil CL, Coker T, Rising SS, Glass N, Platt R. A Conceptual Framework for Group Well-Child Care: A Tool to Guide Implementation, Evaluation, and Research. Matern Child Health J 2023; 27:991-1008. [PMID: 37014564 PMCID: PMC10071241 DOI: 10.1007/s10995-023-03641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To use scoping review methods to construct a conceptual framework based on current evidence of group well-child care to guide future practice and research. METHODS We conducted a scoping review using Arksey and O'Malley's (2005) six stages. We used constructs from the Consolidated Framework for Implementation Research and the quadruple aim of health care improvement to guide the construction of the conceptual framework. RESULTS The resulting conceptual framework is a synthesis of the key concepts of group well-child care, beginning with a call for a system redesign of well-child care to improve outcomes while acknowledging the theoretical antecedents structuring the rationale that supports the model. Inputs of group well-child care include health systems contexts; administration/logistics; clinical setting; group care clinic team; community/patient population; and curriculum development and training. The core components of group well-child care included structure (e.g., group size, facilitators), content (e.g., health assessments, service linkages). and process (e.g., interactive learning and community building). We found clinical outcomes in all four dimensions of the quadruple aim of healthcare. CONCLUSION Our conceptual framework can guide model implementation and identifies several outcomes that can be used to harmonize model evaluation and research. Future research and practice can use the conceptual framework as a tool to standardize model implementation and evaluation and generate evidence to inform future healthcare policy and practice.
Collapse
Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA.
| | - Deborah Wilson
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Ada Fenick
- Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL, 60612, USA
| | - Tumaini Coker
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, USA
| | | | - Nancy Glass
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Rheanna Platt
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| |
Collapse
|
10
|
Coker TR, Liljenquist K, Lowry SJ, Fiscella K, Weaver MR, Ortiz J, LaFontaine R, Silva J, Salaguinto T, Johnson G, Friesema L, Porras-Javier L, Guerra LJS, Szilagyi PG. Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children: A Randomized Clinical Trial. JAMA 2023; 329:1757-1767. [PMID: 37120800 PMCID: PMC10150321 DOI: 10.1001/jama.2023.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
Importance An intervention model (the Parent-focused Redesign for Encounters, Newborns to Toddlers; the PARENT intervention) for well-child care that integrates a community health worker into preventive care services may enhance early childhood well-child care. Objective To examine the effectiveness of the PARENT intervention vs usual care for parents with children younger than 2 years of age. Design, Setting, and Participants A cluster randomized clinical trial was conducted between March 2019 and July 2022. Of the 1283 parents with a child younger than 2 years of age presenting for a well-child visit at 1 of the 10 clinic sites (2 federally qualified health centers in California and Washington) approached for trial participation, 937 were enrolled. Intervention Five clinics implemented the PARENT intervention, which is a team-based approach to care that uses a community health worker in the role of a coach (ie, health educator) as part of the well-child care team to provide comprehensive preventive services, and 5 clinics provided usual care. Main Outcomes and Measures There were 2 primary outcomes: score for parent-reported receipt of recommended anticipatory guidance during well-child visits (score range, 0-100) and emergency department (ED) use (proportion with ≥2 ED visits). The secondary outcomes included psychosocial screening, developmental screening, health care use, and parent-reported experiences of care. Results Of the 937 parents who were enrolled, 914 remained eligible to participate (n = 438 in the intervention group and n = 476 in the usual care group; 95% were mothers, 73% reported Latino ethnicity, and 63% reported an annual income <$30 000). The majority (855/914; 94%) of the children (mean age, 4.4 months at parental enrollment) were insured by Medicaid. Of the 914 parents who remained eligible and enrolled, 785 (86%) completed the 12-month follow-up interview. Parents of children treated at the intervention clinics (n = 375) reported receiving more anticipatory guidance than the parents of children treated at the usual care clinics (n = 407) (mean score, 73.9 [SD, 23.4] vs 63.3 [SD, 27.8], respectively; adjusted absolute difference, 11.01 [95% CI, 6.44 to 15.59]). There was no difference in ED use (proportion with ≥2 ED visits) between the intervention group (n = 376) and the usual care group (n = 407) (37.2% vs 36.1%, respectively; adjusted absolute difference, 1.2% [95% CI, -5.5% to 8.0%]). The effects of the intervention on the secondary outcomes included a higher amount of psychosocial assessments performed, a greater number of parents who had developmental or behavioral concerns elicited and addressed, increased attendance at well-child visits, and greater parental experiences with the care received (helpfulness of care). Conclusions and Relevance The intervention resulted in improvements in the receipt of preventive care services vs usual care for children insured by Medicaid by incorporating community health workers in a team-based approach to early childhood well-child care. Trial Registration ClinicalTrials.gov Identifier: NCT03797898.
Collapse
Affiliation(s)
- Tumaini R. Coker
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Kendra Liljenquist
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Sarah J. Lowry
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, New York
| | | | - Janette Ortiz
- Department of Pediatrics, University of California, Los Angeles
| | - Rachel LaFontaine
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Javier Silva
- School of Public Health, University of Washington, Seattle
| | - Taylor Salaguinto
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
| | - Gina Johnson
- Northeast Valley Health Corporation, San Fernando, California
| | | | | | | | | |
Collapse
|
11
|
Russ CM, Gao Y, Karpowicz K, Lee S, Stephens TN, Trimm F, Yu H, Jiang F, Palfrey J. The Pediatrician Workforce in the United States and China. Pediatrics 2023:191246. [PMID: 37158018 DOI: 10.1542/peds.2022-059143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
From 2019 to 2022, the For Our Children project gathered a team of Chinese and American pediatricians to explore the readiness of the pediatric workforce in each country to address pressing child health concerns. The teams compared existing data on child health outcomes, the pediatric workforce, and education and combined qualitative and quantitative comparisons centered on themes of effective health care delivery outlined in the World Health Organization Workforce 2030 Report. This article describes key findings about pediatric workload, career satisfaction, and systems to assure competency. We discuss pediatrician accessibility, including geographic distribution, practice locations, trends in pediatric hospitalizations, and payment mechanisms. Pediatric roles differed in the context of each country's child health systems and varied teams. We identified strengths we could learn from one another, such as the US Medical Home Model with continuity of care and robust numbers of skilled clinicians working alongside pediatricians, as well as China's Maternal Child Health system with broad community accessibility and health workers who provide preventive care.In both countries, notable inequities in child health outcomes, evolving epidemiology, and increasing complexity of care require new approaches to the pediatric workforce and education. Although child health systems in the United States and China have significant differences, in both countries, a way forward is to develop a more inclusive and broad view of the child health team to provide truly integrated care that reaches every child. Training competencies must evolve with changing epidemiology as well as changing health system structures and pediatrician roles.
Collapse
Affiliation(s)
- Christiana M Russ
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Yijin Gao
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | | | - Shoo Lee
- Mount Sinai Hospital, New York City, New York
- University of Toronto, Toronto, Canada
| | - Timothy Noel Stephens
- Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou, China
| | - Franklin Trimm
- University of South Alabama College of Medicine, Mobile, Alabama; and
| | - Hao Yu
- Harvard Medical School, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Fan Jiang
- Shanghai Children's Medical Center, Shanghai, China
- Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Judith Palfrey
- Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
12
|
Hammon L, Mondzelewski L, Robinson C, Milder E. Well-Child Care Disparities in U.S. Military Health System. Acad Pediatr 2023; 23:363-371. [PMID: 35918041 DOI: 10.1016/j.acap.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe adherence rates for well-child visits among military children in the first 15 months of life and identify any disparities in adherence in a universally insured population. METHODS A retrospective cohort analysis was conducted using the Military Health System data repository which included children who were born between October 2013 and September 2016 and were eligible for TRICARE (the military health insurance program). Children were followed from zero to fifteen months of life to assess adherence with a national Health Effectiveness Data and Information Set (HEDIS) metric of 6 well visits during this period. Differences in adherence rates were evaluated across select demographic characteristics including sponsor rank, race, age, service branch, patient sex, geographic region, number of enrollment sites and provider type. Fitted logistic regression models were used to determine the probability of adherence with the HEDIS metric and identify disparities. RESULTS The final cohort included 168,830 infants. Across all variables, the mean number of well visits was 6.7 with an overall adherence rate of 86%. Child beneficiaries of junior enlisted, Black, and Air Force military members had lower adherence with the HEDIS metric. Enrollment at a single site and having a pediatrician for a primary care manager was associated with higher rates of adherence. CONCLUSIONS Sponsor rank, race, and service branch, along with provider type and number of enrollment sites were significantly associated with the probability of adherence. Further research should evaluate barriers to care that affect a universally insured population.
Collapse
Affiliation(s)
- Laura Hammon
- Department of Pediatrics (L Hammon), Naval Hospital Rota, Spain.
| | - Lisa Mondzelewski
- Department of Pediatrics (L Mondzelewski), Naval Medical Center San Diego, Calif
| | - Camille Robinson
- Division of Adolescent Medicine (C Robinson), Naval Medical Center San Diego, Calif
| | - Edmund Milder
- Division of Pediatric Infectious Diseases (E Milder), Naval Medical Center San Diego, Calif
| |
Collapse
|
13
|
Liljenquist K, Hurst R, Guerra LS, Szilagyi PG, Fiscella K, Porras-Javier L, Coker TR. Time Spent at Well-Child Care Visits for English- and Spanish-Speaking Parents. Acad Pediatr 2023; 23:359-362. [PMID: 35768034 PMCID: PMC10676270 DOI: 10.1016/j.acap.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To measure duration of well-child care (WCC) visits at 2 federally qualified health centers (FQHCs), across 10 clinic sites, and determine if differences exist in visit duration for English- and Spanish-speaking parents. METHODS Upon arrival to their child's 2- to 24-month well visit, a research team member followed families throughout their visit noting start and end times for a series of 5 WCC visit tasks. The average time to complete each visit task for the entire sample was then calculated. Mann-Whitney U tests were run to determine if task completion time differed significantly between English- and Spanish-speaking parents. RESULTS The total sample included 199 parents of infants and children between 2 and 24 months old. Over one third of the sample spoke Spanish as their primary language (37%). The average visit time was 77 minutes (standard deviation [SD] = 48). Median time spent with the clinician was 14 minutes (SD = 5). Clinician visit time was significantly different U = 2608, P < .001, r = 0.38 between English- (median = 15 minutes) and Spanish (median = 11 minutes)-speaking parents. No other significant differences were identified. DISCUSSION Our findings align with previous studies showing the average time spent with a clinician during a WCC visit was 15 minutes. Further, the average time with a clinician was less for Spanish-speaking parents. With limited visit length to address child and family concerns, re-designing the structure and duration of WCC visits is critical to best meet the needs of families living in poverty, and may ensure that Spanish-speaking parents receive appropriate guidance and support without time limitations.
Collapse
Affiliation(s)
- Kendra Liljenquist
- Department of Pediatrics, University of Washington School of Medicine (K Liljenquist and TR Coker), Seattle, Wash; Seattle Children's Research Institute (K Liljenquist, R Hurst, LS Guerra, and TR Coker), Seattle, Wash.
| | - Rachel Hurst
- Seattle Children's Research Institute (K Liljenquist, R Hurst, LS Guerra, and TR Coker), Seattle, Wash
| | - Laura Sotelo Guerra
- Seattle Children's Research Institute (K Liljenquist, R Hurst, LS Guerra, and TR Coker), Seattle, Wash
| | - Peter G Szilagyi
- Department of Pediatrics, David Geffen School of Medicine at UCLA (PG Szilagy and L Porras-Javier), Los Angeles, Calif
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester School of Medicine and Dentistry (K Fiscella), Rochester, NY
| | - Lorena Porras-Javier
- Department of Pediatrics, David Geffen School of Medicine at UCLA (PG Szilagy and L Porras-Javier), Los Angeles, Calif
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine (K Liljenquist and TR Coker), Seattle, Wash; Seattle Children's Research Institute (K Liljenquist, R Hurst, LS Guerra, and TR Coker), Seattle, Wash
| |
Collapse
|
14
|
Penumalee L, Lambert JO, Gonzalez M, Gray M, Partani E, Wilson C, Etz R, Nelson B. "Why Do They Want to Know?": A Qualitative Assessment of Caregiver Perspectives on Social Drivers of Health Screening in Pediatric Primary Care. Acad Pediatr 2023; 23:329-335. [PMID: 35840084 DOI: 10.1016/j.acap.2022.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite strong evidence that social factors have a large influence on child health, systematic screening for social needs is not performed universally in pediatric primary care. This is due to multiple barriers, including concerns about acceptability to families. This study sought to assess family acceptability of social needs screening in pediatric primary care. METHODS Eight semi-structured focus groups were performed with English and Spanish-speaking caregivers of pediatric patients from a diverse academic medical center. Focus groups explored the acceptability of social domains including housing, education, finances, food access, and safety. Focus group transcripts were qualitatively analyzed to identify themes. RESULTS Four salient themes emerged: 1) the acceptability of social determinants of health screening questions was tied to participants' understanding of the connection between the topic and child health, 2) families preferred a warm handoff to community services, 3) families feared child protective services intervention as a result of sharing unmet social needs, and 4) positive provider rapport was an important factor in choosing to share social needs. CONCLUSIONS Pediatric primary care providers should feel comfortable implementing social needs screening when they can clearly explain the connection to child health. They should become knowledgeable about organizations and partners within their communities and feel empowered to connect patients to these resources.
Collapse
Affiliation(s)
- Leena Penumalee
- University of Chicago Pritzker School of Medicine (L Penumalee), Chicago, Ill
| | | | - Martha Gonzalez
- Department of Family Medicine and Population Health, Virginia Commonwealth University (M Gonzalez and R Etz), Richmond, Va
| | - Melanie Gray
- Pediatric Residency Program, Medical University of South Carolina (M Gray), Charleston, SC
| | - Ekta Partani
- Obstetrics-Gynecology Residency Program, Kaiser Permanente (E Partani), Santa Clara, Calif
| | - Celia Wilson
- Department of Pediatrics, Children's Hospital of Richmond at VCU (C Wilson and B Nelson), Richmond, Va
| | - Rebecca Etz
- Department of Family Medicine and Population Health, Virginia Commonwealth University (M Gonzalez and R Etz), Richmond, Va
| | - Bergen Nelson
- Department of Pediatrics, Children's Hospital of Richmond at VCU (C Wilson and B Nelson), Richmond, Va.
| |
Collapse
|
15
|
Sotelo Guerra LJ, Ortiz J, Liljenquist K, Szilagyi PG, Fiscella K, Porras-Javier L, Johnson G, Friesema L, Coker TR. Implementation of a community health worker-focused team-based model of care: What modifications do clinics make? FRONTIERS IN HEALTH SERVICES 2023; 3:989157. [PMID: 36926506 PMCID: PMC10012691 DOI: 10.3389/frhs.2023.989157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
Background Team-based care offers potential for integrating non-clinicians, such as community health workers (CHWs), into the primary care team to ensure that patients and families receive culturally relevant care to address their physical, social, and behavioral health and wellness needs. We describe how two federally qualified health center (FQHC) organizations adapted an evidence-based, team-based model of well-child care (WCC) designed to ensure that the parents of young children, aged 0-3, have their comprehensive preventive care needs met at WCC visits. Methods Each FQHC formed a Project Working Group composed of clinicians, staff, and parents to determine what adaptations to make in the process of implementation of PARENT (Parent-Focused Redesign for Encounters, Newborns to Toddlers), a team-based care intervention that uses a CHW in the role of a preventive care coach. We use the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to chronicle the various intervention modifications and the adaptation process, focusing on when and how modifications occurred, whether it was planned or unplanned, and the reasons and goals for the modification. Results The Project Working Groups adapted several elements of the intervention in response to clinic priorities, workflow, staffing, space, and population need. Modifications were planned and proactive, and were made at the organization, clinic, and individual provider level. Modification decisions were made by the Project Working Group and operationalized by the Project Leadership Team. Examples of modifications include the following: (1) changing the parent coach educational requirement from a Master's degree to a bachelor's degree or equivalent experience to reflect the needs of the coach role; (2) the use of FQHC-specific templates for the coach's documentation of the pre-visit screening in the electronic health record; and (3) the use of electronic social needs referral tools to help the coach track and follow up on social need referrals. The modifications did not change the core elements (i.e., parent coach provision of preventive care services) or intervention goals. Conclusions For clinics implementing team-based care interventions, the engagement of key clinical stakeholders early and often in the intervention adaptation and implementation process, and planning for intervention modifications at both at an organizational level and at a clinical level are critical for local implementation.
Collapse
Affiliation(s)
- Laura J. Sotelo Guerra
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Janette Ortiz
- Department of Pediatrics, University of California, Los Angeles, CA, United States
| | - Kendra Liljenquist
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Peter G. Szilagyi
- Department of Pediatrics, University of California, Los Angeles, CA, United States
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Lorena Porras-Javier
- Department of Pediatrics, University of California, Los Angeles, CA, United States
| | - Gina Johnson
- Northeast Valley Health Corporation, San Fernando, CA, United States
| | | | - Tumaini R. Coker
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| |
Collapse
|
16
|
Shahidullah JD, Petts R, Broder-Fingert S. Toward Antiracism Pediatric Practice: The Role of System Navigation in the Medical Home. J Dev Behav Pediatr 2022; 43:537-539. [PMID: 36115018 DOI: 10.1097/dbp.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Rachel Petts
- Fairleigh Dickinson University, Teaneck, NJ; and
| | | |
Collapse
|
17
|
DeWitt A, Kientz J, Coker TR, Liljenquist K. mHealth Technology Design and Evaluation for Early Childhood Health Promotion: Systematic Literature Review. JMIR Pediatr Parent 2022; 5:e37718. [PMID: 36201391 PMCID: PMC9585442 DOI: 10.2196/37718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Recent increases in smartphone ownership among underserved populations have inspired researchers in medicine, computing, and health informatics to design and evaluate mobile health (mHealth) interventions, specifically for those supporting child development and growth. Although these interventions demonstrate possible effectiveness at larger scales, few of these interventions are evaluated to address racial disparities and health equity, which are known factors that affect relevance, uptake, and adherence in target populations. OBJECTIVE In this study, we aimed to identify and document the current design and evaluation practices of mHealth technologies that promote early childhood health, with a specific focus on opportunities for those processes to address health disparities and health equity. METHODS We completed a systematic literature review of studies that design and evaluate mHealth interventions for early childhood health promotion. We then analyzed these studies to identify opportunities to address racial disparities in early- and late-stage processes and to understand the potential efficacy of these interventions. RESULTS Across the literature from medical, computing, and health informatics fields, we identified 15 articles that presented a design or evaluation of a parent-facing health intervention. We found that using mobile-based systems to deliver health interventions was generally well accepted by parents of children aged <5 years. We also found that, when measured, parenting knowledge of early childhood health topics and confidence to engage in health-promoting behaviors improved. Design and evaluation methods held internal consistency within disciplines (eg, experimental study designs were the most prevalent in medical literature, while computing researchers used user-centered design methods in computing fields). However, there is little consistency in design or evaluation methods across fields. CONCLUSIONS To support more interventions with a comprehensive design and evaluation process, we recommend attention to design at the intervention (eg, reporting content sources) and system level; interdisciplinary collaboration in early childhood health intervention development can lead to large-scale deployment and success among populations. TRIAL REGISTRATION PROSPERO CRD42022359797; https://tinyurl.com/586nx9a2.
Collapse
Affiliation(s)
- Akeiylah DeWitt
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Julie Kientz
- Department of Human-Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Tumaini R Coker
- Seattle Childrens Research Institute, Seattle, WA, United States
| | - Kendra Liljenquist
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| |
Collapse
|
18
|
Willis DW, Eddy JM. Early relational health: Innovations in child health for promotion, screening, and research. Infant Ment Health J 2022; 43:361-372. [PMID: 35537061 DOI: 10.1002/imhj.21980] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 02/28/2022] [Indexed: 11/06/2022]
Abstract
Relational experiences during infancy and early childhood are key drivers for building health, social emotional development, and learning capacities, each vital for wellbeing. The U.S. child health sectors share a commitment to universal health promotion, prevention and early intervention, and a growing enthusiasm for the research-affirmed primacy of caregiver-child interactions during the critical first 1000 days of life. Given our nation's growing children's mental health crisis, racial justice awakening and the need to reimagine equitable supports for young families post-COVID19, the child health sectors seek new tools and clinical approaches that blend science-to-practice innovations with co-developed activities that are meaningful to families. This special section brings together papers about a journey of co-discovery between researchers, clinicians, and parents during the development and refinement of new video- and interview-based dyadic relational screening and monitoring tools. The collection of papers addresses a range of topics including early relational health (ERH), development and validation of the Early Relational Health Screen, its application within research and clinical settings, and thoughtful discussions from multiple perspectives. Informed by the diversity informed tenets, this journey highlights not only science-informed approaches, but also co-development with families of equitable approaches to understanding and serving children and their caregivers.
Collapse
Affiliation(s)
- David W Willis
- Center for the Study of Social Policy, Washington, District of Columbia, USA
| | - J Mark Eddy
- Texas Center for Equity Promotion, The University of Texas at Austin, Austin, Texas, USA
| |
Collapse
|
19
|
Parental COVID-19 Vaccine Hesitancy in Diverse Communities: A National Survey. Acad Pediatr 2022; 22:1399-1406. [PMID: 35803490 PMCID: PMC9254650 DOI: 10.1016/j.acap.2022.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We surveyed a diverse group of US participants to understand parental coronavirus disease 2019 (COVID-19) vaccine hesitancy. METHODS We administered a telephone and online survey from May 7 to June 7, 2021 using stratified sampling to ensure robust sample sizes of racial and ethnic minorities. Of the 20,280 contacted, 12,288 respondents completed the survey (response rate 61%). We used chi-square tests and adjusted risk ratios to compare results by racial/ethnic group. RESULTS Overall, 23% of parents stated that they plan to (or have) vaccinated their children; 30% said that they would not vaccinate their children, and 25% were unsure. Latino/a, Native American, and Asian American-Pacific Islander (AAPI) parents were generally more likely to vaccinate their children than Black or White parents. After adjusting for demographic factors, AAPI parents were significantly more likely to vaccinate their children than were others. Of parents who said that they would not vaccinate their child, 55% stated it was due to insufficient research. However, over half of parents stated that they would follow their child's health care provider's recommendations. After adjusting for demographic factors, trust in their primary care doctor was significantly lower among AAPI, Black, and Native American parents than White parents. CONCLUSIONS Parental vaccine hesitancy was similar overall, but drivers of hesitancy varied by racial/ethnic groups. While the perception that vaccines had been "insufficiently researched" was a major concern among all groups, we found that parents are generally inclined to follow health providers' recommendations. Health professionals can play an important role in COVID-19 vaccine education and should provide access to vaccines.
Collapse
|
20
|
Schickedanz A, Szilagyi PG, Dreyer B. Child Poverty and Health in the United States: Introduction and Executive Summary. Acad Pediatr 2021; 21:S81-S85. [PMID: 34740430 DOI: 10.1016/j.acap.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Affiliation(s)
- Adam Schickedanz
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz and PG Szilagyi), Los Angeles, Calif.
| | - Peter G Szilagyi
- Department of Pediatrics, David Geffen School of Medicine at UCLA (A Schickedanz and PG Szilagyi), Los Angeles, Calif
| | - Benard Dreyer
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, Bellevue Hospital Center (B Dreyer), New York, NY
| |
Collapse
|