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Godoy L, Williams R, Druskin L, Fleece H, Bergen S, Avent G, Robb A, Biel MG, Wissow LS, Beers LS, Long M. Linking Primary Care to Community-Based Mental Health Resources via Family Navigation and Phone-Based Care Coordination. J Clin Psychol Med Settings 2024; 31:471-492. [PMID: 38265697 DOI: 10.1007/s10880-023-09987-9] [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: 11/13/2023] [Indexed: 01/25/2024]
Abstract
Family navigation (FN) and phone-based care coordination may improve linkages from primary care to community-based mental health referrals, but research on their differential impact is limited. This mixed-methods study compared FN and phone-based care coordination in connecting families to mental health services from primary care. Families of children (56.3% male, mean age = 10.4 years, 85.4% Black) were sequentially assigned to either receive FN through a family-run organization or phone-based coordination via the child psychiatry access program (CPAP). Caregiver-reported children's mental health improved in both groups and both groups were satisfied with services. More families in the CPAP group had appointments made or completed (87%) than families in the FN group (71%) though the difference was not statistically significant. Future research with a larger sample that matches family needs and preferences (e.g., level and type of support) with navigation services would be beneficial.
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Affiliation(s)
- Leandra Godoy
- Children's National Hospital, Washington, DC, USA.
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Child Health Advocacy Institute, Children's National Hospital, 1 Inventa Place, Silver Spring, MD, 20910, USA.
| | | | | | | | | | - Gail Avent
- Total Family Care Coalition, Washington, DC, USA
| | - Adelaide Robb
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Matthew G Biel
- Georgetown University Medical Center/MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Lee Savio Beers
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Melissa Long
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Lopez KN, Allen KY, Baker-Smith CM, Bravo-Jaimes K, Burns J, Cherestal B, Deen JF, Hills BK, Huang JH, Lizano Santamaria RW, Lodeiro CA, Melo V, Moreno JS, Nuñez Gallegos F, Onugha H, Pastor TA, Wallace MC, Ansah DA. Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States. J Cardiovasc Dev Dis 2024; 11:36. [PMID: 38392250 PMCID: PMC10888593 DOI: 10.3390/jcdd11020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.
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Affiliation(s)
- Keila N Lopez
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kiona Y Allen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Carissa M Baker-Smith
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Joseph Burns
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bianca Cherestal
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO 64108, USA
| | - Jason F Deen
- Department of Pediatrics and Medicine, University of Washington, Seattle, WA 98105, USA
| | - Brittany K Hills
- Division of Pediatric Cardiology, UT Southwestern, Children's Health, Dallas, TX 75390, USA
| | - Jennifer H Huang
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Carlos A Lodeiro
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Valentina Melo
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jasmine S Moreno
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Flora Nuñez Gallegos
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94158, USA
| | - Harris Onugha
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tony A Pastor
- Division of Pediatric Cardiology, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Michelle C Wallace
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Deidra A Ansah
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
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Kolodziej D, Wolkwitz P, Schön G, Siefert S, Pawils S. Evaluation of a Child-centred Psychosocial Healthcare Intervention (KIDPROTEKT) - Results of a Cluster Randomized Controlled Trial in Paediatric and Gynaecologic Practices. INTERVENCION PSICOSOCIAL 2023; 32:33-42. [PMID: 37361631 PMCID: PMC10268543 DOI: 10.5093/pi2023a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/11/2022] [Indexed: 06/28/2023]
Abstract
KID-PROTEKT is a child-centred psychosocial healthcare intervention which aims at improving the identification of psychosocial needs and navigation in the outpatient gynaecologic and paediatric setting. In this cluster randomized-controlled trail we examined the effect of KID-PROTEKT on the referrals (to support services) in comparison to the regular gynaecologic and paediatric outpatient healthcare . A variant based on the qualification of the healthcare providers (qualified treatment, QT) and a variant with social worker (supported treatment, ST) were compared to the regular healthcare (treatment as usual, TAU). Twenty-four gynaecologic and paediatric practices were randomized to one of three study arms. Therefore 8,458 pregnant women and families recruited in one of these practices were enrolled in the study. Participating patients reported on average 1.73 (SD = 1.34) psychosocial risks. In total 522 patients were linked to a support service. Compared to TAU, the probability of a referral was significantly higher in QT (OR = 10.70) and ST (OR = 11.28). Also, a higher number of psychosocial risks were linked to a referral (OR = 2.72). These findings support the importance of a psychosocial assessment in the gynaecologic and paediatric setting.
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Affiliation(s)
- Désirée Kolodziej
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Philipp Wolkwitz
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Gerhard Schön
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
| | - Sönke Siefert
- Catholic Children’s Hospital WilhelmstiftHamburgGermanyCatholic Children’s Hospital Wilhelmstift, Hamburg, Germany
| | - Silke Pawils
- University Medical Center Hamburg-EppendorfHamburgGermanyUniversity Medical Center Hamburg-Eppendorf, Hamburg, Germany;
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A Patient Navigator Intervention Supporting Timely Transfer Care of Adolescent and Young Adults of Hispanic Descents Attending an Urban Primary Care Pediatrics Clinic. Pediatr Qual Saf 2021; 6:e391. [PMID: 33718746 PMCID: PMC7952101 DOI: 10.1097/pq9.0000000000000391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
While comprehensive health care transition is associated with better health outcomes, navigating health care transition can be difficult for adolescents and young adults (AYAs), especially those with fewer resources. Our practice serves low-income patients from birth to their 26th birthday; many are medically and socially complex and experience several obstacles to navigate care. As a result, most have not initiated a transfer to adult medicine by age 25. This quality-improvement initiative was designed to implement a structured intervention that supports the planned transfer of care to adult primary care. Methods Informed by our baseline data on all patients eligible to transfer care, we designed a patient outreach workflow centered on a patient navigator (PN) intervention. We used a Plan-Do-Study-Act format to optimize our process and run charts to evaluate our intervention. Results Over 3 years, our PN reached out to 96% of patients (n = 226) eligible to transfer care and offered transfer assistance in person or in writing. Among those surveyed, 92% (n = 93) reported awareness of our practice transition policy, and 83% (n = 64) rated their confidence to transfer care at 3 or higher on a 5-point scale. Conclusions AYAs are aware of our practice transition policy, yet they welcome in-person transfer assistance. This intervention seems to improve their confidence to transfer care. However, despite PN outreach efforts, many remain empaneled in our practice and thus lack the self-care skills necessary to complete the transfer independently. Future transition interventions should address AYA's self-management skills toward transition readiness.
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Godoy L, Hodgkinson S, Robertson HA, Sham E, Druskin L, Wambach CG, Beers LS, Long M. Increasing Mental Health Engagement From Primary Care: The Potential Role of Family Navigation. Pediatrics 2019; 143:peds.2018-2418. [PMID: 30877145 DOI: 10.1542/peds.2018-2418] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/24/2022] Open
Abstract
Early engagement in mental health intervention is critical, yet the vast majority of children who are experiencing mental health concerns are not receiving needed services. Pediatric primary care clinics have been recognized as an ideal setting in which to identify and address mental health problems early, although engagement in mental health services within primary care and in community-based settings remains low. Navigators, or individuals with experience in navigating the mental health system, have been highlighted as promising partners in efforts to improve engagement in mental health services. Navigation has a growing body of research support among adults and in targeting medical concerns, but there has been limited research on integrating family navigators into pediatric primary care settings to address mental health concerns. Despite this gap in the evidence base, we believe there is significant promise for the use of this model in addressing children's mental health needs. In this report, we discuss factors contributing to high levels of unmet mental health needs and low levels of engagement in mental health services, the role that navigators can play in increasing engagement in mental health care, and implications and recommendations related to integrating mental health-focused family navigators into pediatric primary care settings.
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Affiliation(s)
- Leandra Godoy
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia; .,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Stacy Hodgkinson
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | | | - Elyssa Sham
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Lindsay Druskin
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | | | - Lee Savio Beers
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Melissa Long
- Division of General and Community Pediatrics, Children's National Health System, Washington, District of Columbia.,Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
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