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Turuba R, Katan C, Marchand K, Brasset C, Ewert A, Tallon C, Fairbank J, Mathias S, Barbic S. Weaving community-based participatory research and co-design to improve opioid use treatments and services for youth, caregivers, and service providers. PLoS One 2024; 19:e0297532. [PMID: 38635804 PMCID: PMC11025903 DOI: 10.1371/journal.pone.0297532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/30/2023] [Indexed: 04/20/2024] Open
Abstract
Integrating the voices of service users and providers in the design and delivery of health services increases the acceptability, relevance, and effectiveness of services. Such efforts are particularly important for youth opioid use treatments and services, which have failed to consider the unique needs of youth and families. Applying community-based participatory research (CBPR) and co-design can facilitate this process by contextualizing service user experiences at individual and community levels and supporting the collaborative design of innovative solutions for improving care. However, few studies demonstrate how to effectively integrate these methods and engage underserved populations in co-design. As such, this manuscript describes how our team wove CBPR and co-design methods to develop solutions for improving youth opioid use treatments and services in Canada. As per CBPR methods, national, provincial, and community partnerships were established to inform and support the project's activities. These partnerships were integral for recruiting service users (i.e., youth and caregivers) and service providers to co-design prototypes and support local testing and implementation. Co-design methods enabled understanding of the needs and experiences of youth, caregivers, and service providers, resulting in meaningful community-specific innovations. We used several engagement methods during the co-design process, including regular working group meetings, small group discussions, individual interviews and consultations, and feedback grids. Challenges involved the time commitment and resources needed for co-design, which were exacerbated by the COVID-19 pandemic and limited our ability to engage a diverse sample of youth and caregivers in the process. Strengths of the study included youth and caregiver involvement in the co-design process, which centered around their lived experiences; the therapeutic aspect of the process for participants; and the development of innovations that were accepted by design partners.
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Affiliation(s)
- Roxanne Turuba
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Kirsten Marchand
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | | | - Alayna Ewert
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Corinne Tallon
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Steve Mathias
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
- Providence Research, Vancouver, British Columbia, Canada
| | - Skye Barbic
- Foundry, Vancouver, British Columbia, Canada
- Providence Health Care, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
- Providence Research, Vancouver, British Columbia, Canada
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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.
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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
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Gregory EF, White E, Wu KK, McPeak KE, Fiks AG. Implementing team-based newborn well care: Perspectives of nurses and physicians. J Pediatr Nurs 2022; 65:22-28. [PMID: 35398632 DOI: 10.1016/j.pedn.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Pediatric primary care redesign includes changes to clinical teams and clinical workflows. This study described the perspectives of pediatric clinicians on their experience with redesign. DESIGN AND METHODS This qualitative study explored clinician perspectives on a newborn care redesign pilot at a pediatric primary care site. Newborn Hallway (NBH), implemented in 2019, clustered morning newborn visits with a single physician, increased RN staffing, and provided newborn-specific training for RNs. NBH also revised visit documentation templates to promote communication between RNs and physicians and shared completion of history taking and education. We conducted semi-structured qualitative interviews with clinicians. The interview guide was developed using the Consolidated Framework for Implementation Research. Interviews were recorded and transcribed, and coded using an integrated approach. RESULTS We interviewed 17 staff (8 physicians, 8 RNs, 1 nurse practitioner) from 3/2020 to 1/2021. Clinicians reported that NBH implementation was facilitated by widespread agreement on baseline challenges to newborn care, and interest in optimizing roles for RNs. Clinicians believed NBH facilitated teamwork, which mitigated unpredictability in newborn needs and arrival times, and improved staff satisfaction. Perceived barriers to NBH included staffing constraints and ambivalence about whether sharing tasks with RNs would negatively influence patient relationships and continuity. CONCLUSIONS Pediatric primary care redesign focused on sharing tasks between RNs and physicians can promote teamwork and address unpredictability in clinical settings. PRACTICE IMPLICATIONS Resolving questions about how redesign influences patient continuity and trust, and clarifying optimal staffing may help facilitate adoption of clinical team and workflow innovations.
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Affiliation(s)
- Emily F Gregory
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, USA; The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, USA.
| | - Eliza White
- Care Network, Children's Hospital of Philadelphia, USA
| | - Katherine K Wu
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, USA
| | - Katie E McPeak
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, USA; The Possibilities Project: Innovation in Pediatric Primary Care, Children's Hospital of Philadelphia, USA
| | - Alexander G Fiks
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, USA; The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, USA; The Possibilities Project: Innovation in Pediatric Primary Care, Children's Hospital of Philadelphia, USA
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Scherr KA, Wong CA. Emergency Department Use in Adolescents and Young Adults: The Role of the Well-care Visit. J Adolesc Health 2022; 70:1-2. [PMID: 34930564 DOI: 10.1016/j.jadohealth.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Karen A Scherr
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Charlene A Wong
- Children's Health and Discovery Initiative, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina; Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Hurst R, Liljenquist K, Lowry SJ, Szilagyi PG, Fiscella KA, Weaver MR, Porras-Javier L, Ortiz J, Sotelo Guerra LJ, Coker TR. A Parent Coach-Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27054. [PMID: 34842563 PMCID: PMC8663704 DOI: 10.2196/27054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator (Parent Coach) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. OBJECTIVE This study aims to evaluate the impact of PARENT using a cluster randomized controlled trial. METHODS This study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California. We conducted a cluster randomized controlled trial that included 916 families with children aged ≤12 months at the time of the baseline survey. Parents will be followed up at 6 and 12 months after enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination and any concerns that require a clinician's attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health-related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. Our primary outcomes were receipt of anticipatory guidance and emergency department use. RESULTS Participant recruitment began in March 2019. After recruitment, 6- and 12-month follow-up surveys will be completed. As of August 30, 2021, we enrolled a total of 916 participants. CONCLUSIONS This large pragmatic trial of PARENT in partnership with federally qualified health centers will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. TRIAL REGISTRATION ClinicalTrials.gov: NCT03797898; https://clinicaltrials.gov/ct2/show/NCT03797898. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/27054.
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Affiliation(s)
- Rachel Hurst
- School of Public Health, New York University, New York, NY, United States
| | - Kendra Liljenquist
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Sarah J Lowry
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Peter G Szilagyi
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Marcia R Weaver
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
- Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, WA, United States
| | - Lorena Porras-Javier
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Janette Ortiz
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Tumaini R Coker
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
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Amer YS, Al Nemri A, Osman ME, Saeed E, Assiri AM, Mohamed S. Perception, attitude, and satisfaction of paediatric physicians and nurses towards clinical practice guidelines at a university teaching hospital. J Eval Clin Pract 2019; 25:543-549. [PMID: 29611621 DOI: 10.1111/jep.12923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 01/09/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES To explore perception, attitude, and satisfaction of paediatric clinicians, trainees, and nurses at King Khalid University Hospital towards clinical practice guidelines (CPGs) including the locally adapted diabetic ketoacidosis CPG (DKA-CPG). METHODS A cross-sectional survey was distributed to 260 doctors and nurses working in the paediatrics department. RESULTS The response rate was 95.4%. The respondents had a positive perception and attitude towards general CPGs and specifically for the DKA-CPG; 98.7% thought CPGs were useful sources of advice, improved safety, and decreased risk, and reduced variation in practice. A total of 99.2% thought CPGs were good clinical tools, 98.3% satisfied with, had confidence in well-developed CPGs, and would recommend them to their colleagues to use, and 94.6% agreed they were cost-effective. The preferred format for CPGs was paper (46.6%) and electronic (42.9%). The DKA-CPG helped in managing patients and respondents were all satisfied and had confidence with it (100%). The rationale and objectives of the DKA-CPG were clear for 99.25%; 98.5% thought the layout was clear and well organized and user-friendly (96.2%). Compared with nurses, physicians had a higher perception towards CPGs in general (P < .05) and the DKA-CPG (P < .05). CONCLUSIONS The paediatric doctors, and nurses have a great perception and satisfaction and positive attitude towards CPGs in general, towards the paediatric diabetic ketoacidosis CPG in particular, which in turn had a positive impact on the acceptability and implementation of the CPGs. These findings could help in sustaining a safe and high-quality health care environment through implementation of evidence-based CPGs.
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Affiliation(s)
- Yasser Sami Amer
- Quality Management Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Alexandria Centre for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt
| | - Abdulrahman Al Nemri
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Elfaki Osman
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Asaad Mohamed Assiri
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Sarar Mohamed
- Department of Paediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Prince Abdullah Bin Khalid Celiac Disease Research Chair, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia.,Department of Paediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Porras-Javier L, Bromley E, Lopez M, Coker TR. Challenges to Effective Primary Care-Specialty Communication and Coordination in the Mental Health Referral and Care Process for Publicly Insured Children. J Behav Health Serv Res 2019; 45:668-677. [PMID: 29582232 DOI: 10.1007/s11414-018-9585-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Publicly insured children needing referral to mental health (MH) services often do not access or receive services. The objective of this study was to identify gaps in communication and coordination between primary care providers (PCPs) and MH providers during the MH referral and care process for publicly insured children. Thirteen semi-structured interviews were conducted with 10 PCPs and staff from a federally qualified health center (FQHC) and 6 MH providers and staff from two local MH clinics. Interview participants identified multiple gaps in communication throughout the care process and different phases as priorities for improvement. PCPs described primary care-MH communication challenges during early phases, while MH providers described coordination challenges in transferring patients back to primary care for ongoing mental health management. Strategies are needed to improve primary care-specialty MH communication and coordination throughout all phases of the referral and care process, particularly at initial referral and transfer back to primary care.
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Affiliation(s)
- Lorena Porras-Javier
- UCLA Children's Discovery and Innovation Institute, Geffen School of Medicine at UCLA, Box 951752 10833 Le Conte Avenue, Room 12-476, Los Angeles, CA, 90095, USA
| | - Elizabeth Bromley
- Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, Box 957082 10920 Wilshire Blvd, Suite 300, Los Angeles, CA, 90095-7082, USA
| | - Maria Lopez
- UCLA Children's Discovery and Innovation Institute, Geffen School of Medicine at UCLA, Box 951752 10833 Le Conte Avenue, Room 12-476, Los Angeles, CA, 90095, USA
| | - Tumaini R Coker
- Seattle Children's Research Institute, 2001 8th Avenue, Room 650, Seattle, WA, 98121, USA.
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Jones KA, Do S, Porras-Javier L, Contreras S, Chung PJ, Coker TR. Feasibility and Acceptability in a Community-Partnered Implementation of CenteringParenting for Group Well-Child Care. Acad Pediatr 2018; 18:642-649. [PMID: 29890229 PMCID: PMC10937253 DOI: 10.1016/j.acap.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/29/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND In a community-academic partnership, we implemented a group-based model for well-child care (WCC) (CenteringParenting) and conducted a pilot test for feasibility and acceptability among families at a federally qualified health center (FQHC). METHODS The FQHC implemented CenteringParenting for all WCC visits in the first year of life, starting at the 2-week visit. Over a 14-month time period, parents from each new CenteringParenting group were enrolled into the study. Baseline data were collected at enrollment (infant age < 31 days) and again at a 6-month follow-up survey. Main outcomes were feasibility and acceptability of CenteringParenting; we also collected exploratory measures (parent experiences of care, utilization, self-efficacy, and social support). RESULTS Of the 40 parent-infant dyads enrolled in the pilot, 28 CenteringParenting participants completed the 6-month follow-up assessment. The majority of infants were Latino, black, or "other" race/ethnicity; over 90% were Medicaid insured. Of the 28 CenteringParenting participants who completed the 6-month follow-up, 25 completed all visits between ages 2 weeks and 6 months in the CenteringParenting group. Of the CenteringParenting participants, 97% to 100% reported having adequate time with their provider and sufficient patient education and having their needs met at visits; most reported feeling comfortable at the group visit, and all reported wanting to continue CenteringParenting for their WCC. CenteringParenting participants' mean scores on exploratory measures demonstrated positive experiences of care, overall satisfaction of care, confidence in parenting, and parental social support. CONCLUSIONS A community-academic partnership implemented CenteringParenting; the intervention was acceptable and feasible for a minority, low-income population. We highlight key challenges of implementation.
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Affiliation(s)
- Kai A Jones
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | - Paul J Chung
- Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA; UCLA Fielding School of Public Health, Los Angeles, Calif
| | - Tumaini R Coker
- University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Wash.
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Connor KA, Duran G, Faiz-Nassar M, Mmari K, Minkovitz CS. Feasibility of Implementing Group Well Baby/Well Woman Dyad Care at Federally Qualified Health Centers. Acad Pediatr 2018; 18:510-515. [PMID: 28919481 DOI: 10.1016/j.acap.2017.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/08/2017] [Accepted: 09/10/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Group care has been shown to be effective for delivery of infant well child care. Centering Parenting (CP) is a model of group dyad care for mothers and infants. CP might improve quality and efficiency of preventive care, particularly for low-income families. Federally qualified health centers (FQHCs) might be optimal sites for implementation, however, facilitators and barriers might be unique. The aim of this qualitative study was to assess stakeholder perspectives on the feasibility of implementing CP in FQHCs in Baltimore. METHODS Semistructured interviews were conducted with mothers, clinicians, staff, and administrators recruited from 2 FQHCs using purposive sampling. Interviews were recorded, transcribed verbatim, and uploaded to Atlas.ti version 7.0 (Atlas.ti Scientific Software Development, GmbH Berlin, Germany) for analysis. Using an inductive thematic analysis approach, 2 investigators coded the transcripts. Matrices of key codes were developed to identify themes and patterns across stakeholder groups. RESULTS Interviews were completed with 26 mothers and 16 clinicians, staff, and administrators. Most participants considered CP desirable. Facilitators included: peer support and education, emphasis on maternal wellness, and increased patient and clinician satisfaction. Barriers included: exposure to "others," scheduling and coordination of care, productivity, training requirements, and cost. Parenting experience did not appear to affect perspectives on CP. CONCLUSIONS Perceptions regarding facilitators and barriers to CP implementation in FQHCs are similar to existing group well-child care literature. The benefit of emphasis on maternal wellness is a unique finding. Maternal wellness integration might make CP a particularly desirable model for implementation at FQHCs, but potential systems barriers must be addressed.
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Affiliation(s)
- Katherine A Connor
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Gabriela Duran
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Mariam Faiz-Nassar
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kristin Mmari
- Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Cynthia S Minkovitz
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
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Lazar M, Davenport L. Barriers to Health Care Access for Low Income Families: A Review of Literature. J Community Health Nurs 2018; 35:28-37. [DOI: 10.1080/07370016.2018.1404832] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Malerie Lazar
- College of Nursing, The University of Tennessee, Knoxville, Tennessee
| | - Lisa Davenport
- College of Nursing, The University of Tennessee, Knoxville, Tennessee
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Mimila NA, Chung PJ, Elliott MN, Bethell CD, Chacon S, Biely C, Contreras S, Chavis T, Bruno Y, Moss T, Coker TR. Well-Child Care Redesign: A Mixed Methods Analysis of Parent Experiences in the PARENT Trial. Acad Pediatr 2017; 17:747-754. [PMID: 28232142 PMCID: PMC5555836 DOI: 10.1016/j.acap.2017.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/23/2017] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), is a well-child care (WCC) model that has demonstrated effectiveness in improving the receipt of comprehensive WCC services and reducing emergency department utilization for children aged 0 to 3 in low-income communities. PARENT relies on a health educator ("parent coach") to provide WCC services; it utilizes a Web-based previsit prioritization/screening tool (Well-Visit Planner) and an automated text message reminder/education service. We sought to assess intervention feasibility and acceptability among PARENT trial intervention participants. METHODS Intervention parents completed a survey after a 12-month study period; a 26% random sample of them were invited to participate in a qualitative interview. Interviews were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis; survey responses were analyzed using bivariate methods. RESULTS A total of 115 intervention participants completed the 12-month survey; 30 completed a qualitative interview. Nearly all intervention participants reported meeting with the coach, found her helpful, and would recommend continuing coach-led well visits (97-99%). Parents built trusting relationships with the coach and viewed her as a distinct and important part of their WCC team. They reported that PARENT well visits more efficiently used in-clinic time and were comprehensive and family centered. Most used the Well-Visit Planner (87%), and found it easy to use (94%); a minority completed it at home before the visit (18%). Sixty-two percent reported using the text message service; most reported it as a helpful source of new information and a reinforcement of information discussed during visits. CONCLUSIONS A parent coach-led intervention for WCC for young children is a model of WCC delivery that is both acceptable and feasible to parents in a low-income urban population.
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Affiliation(s)
- Naomi A. Mimila
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Paul J. Chung
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA,RAND, Santa Monica, CA,UCLA Fielding School of Public Health, Los Angeles, CA
| | | | | | - Sandra Chacon
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Christopher Biely
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sandra Contreras
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | - Tanesha Moss
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tumaini R. Coker
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA,RAND, Santa Monica, CA
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Coker TR, Chacon S, Elliott MN, Bruno Y, Chavis T, Biely C, Bethell CD, Contreras S, Mimila NA, Mercado J, Chung PJ. A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial. Pediatrics 2016; 137:e20153013. [PMID: 26908675 PMCID: PMC4771128 DOI: 10.1542/peds.2015-3013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine the effects of a new model for well-child care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families. METHODS PARENT includes 4 elements designed by using a stakeholder-engaged process: (1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each well-visit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey-PLUS was used to assess receipt of recommended WCC services at 12 months' postenrollment. Intervention effects were examined by using bivariate analyses. RESULTS A total of 251 parents with a child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than $20,000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fifty-two percent fewer intervention children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization. CONCLUSIONS A parent coach-led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.
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Affiliation(s)
- Tumaini R. Coker
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;,RAND, Santa Monica, California
| | - Sandra Chacon
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | | | - Christopher Biely
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Sandra Contreras
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Naomi A. Mimila
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeffrey Mercado
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Paul J. Chung
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;,RAND, Santa Monica, California;,UCLA Fielding School of Public Health, Los Angeles, California
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13
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Jones MN, Brown CM, Widener MJ, Sucharew HJ, Beck AF. Area-Level Socioeconomic Factors Are Associated With Noncompletion of Pediatric Preventive Services. J Prim Care Community Health 2016; 7:143-8. [PMID: 26883436 DOI: 10.1177/2150131916632361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined 4872 infants born consecutively, 2011-2012, and seen at 3 primary care centers to determine whether area-based socioeconomic measures were associated with noncompletion of common preventive services within the first 15 months. Addresses were geocoded and linked to census tract poverty, adult educational attainment, and household vehicle ownership rates. The quartile of patients in the highest poverty (adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.01-1.54) and lowest vehicle ownership tracts (aOR 1.32; 95% CI 1.07-1.63) had significantly increased odds of service noncompletion. There were significant spatial clusters of low completion in Cincinnati's urban core. These findings have implications for preventive service delivery.
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Affiliation(s)
- Margaret N Jones
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Courtney M Brown
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Heidi J Sucharew
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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14
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Zur J, Jones E. Racial and Ethnic Disparities among Pediatric Patients at Community Health Centers. J Pediatr 2015; 167:845-50. [PMID: 26239926 DOI: 10.1016/j.jpeds.2015.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/22/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To assess racial/ethnic disparities in pediatric utilization of community health centers (CHCs) among a nationally representative sample. STUDY DESIGN Using the 2009 Health Center Patient Survey, a nationally representative sample of CHC patients, demographic characteristics, health conditions, and service utilization were examined for patients under 18 years old (n = 590). Negative binomial and logistic regression models assessed disparities in access to routine care, ambulatory service intensity, and hospital utilization. RESULTS Racial/ethnic disparities were not present for well-child visits or dental checkups. However, disparities in ambulatory care service intensity and hospital use were observed. Compared with white children, Hispanic children had fewer CHC visits (incidence rate ratio [IRR] 0.62; 95% CI 0.41-0.95), and fewer visits to other ambulatory providers (IRR 0.30; 95% CI 0.15-0.61). Black children had fewer CHC visits (IRR 0.46; 95% CI 0.31-0.70) and fewer visits to other ambulatory providers (IRR 0.23; 95% CI 0.06-0.91), and were also less likely to have been hospitalized (OR 0.04; 95% CI 0.01-0.26). CONCLUSIONS Study limitations included the cross-sectional study design, the self-reported data, and the age of the data. Nevertheless, this study demonstrates that there are fewer disparities among children who visit CHCs in comparison with national trends, but there is still room for improvement. Future initiatives should address remaining challenges in ensuring access to care for all children in underserved communities.
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Affiliation(s)
- Julia Zur
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
| | - Emily Jones
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC; Division of Behavioral Health and Intellectual Disabilities Policy, Office of Disability, Aging, and Long-Term Care Policy, Office of the Assistant Secretary for Planning and Evaluation, United States Department of Health and Human Services, Washington, DC
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15
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Rushton FE, Byrne WW, Darden PM, McLeigh J. Enhancing child safety and well-being through pediatric group well-child care and home visitation: The Well Baby Plus Program. CHILD ABUSE & NEGLECT 2015; 41:182-189. [PMID: 25636524 DOI: 10.1016/j.chiabu.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The focus of this article is on an innovative strengths-based child protection effort initiated in Beaufort, South Carolina, that involved working with local systems and structures. Specifically, the program was a school-health partnership that sought to modify services provided to low-resource families to improve child outcomes. The primary components of the prevention program were home visiting and group well visits (GWVs). This article describes the program and the effects of the combined approach on health care utilization, child health status, and parental competence for families with low socioeconomic status. A matched pairs analysis of 102 families (51 intervention and 51 comparison families) was conducted. WB+ families were significantly more likely to attend all scheduled well-child visits (65% vs. 37%) and to be fully immunized (98% vs. 82%) than matched families who received traditional pediatric care. Intervention families had significantly greater recall of anticipatory guidance on safety (65% vs. 41%) and had greater satisfaction with care. Intervention infants were also noted to be statistically less likely to be overweight at 15 months of age (8% vs. 24%). The study demonstrated benefits on child health and parenting competence among families with low socioeconomic status. Implications for practice are discussed.
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Affiliation(s)
| | - Westley W Byrne
- Institute for Families in Society, University of South Carolina, USA
| | - Paul M Darden
- Department of Pediatrics, Medical University of South Carolina, USA
| | - Jill McLeigh
- Kempe Center for Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, USA
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Coker TR, Moreno C, Shekelle PG, Schuster MA, Chung PJ. Well-child care clinical practice redesign for serving low-income children. Pediatrics 2014; 134:e229-39. [PMID: 24936004 PMCID: PMC4067638 DOI: 10.1542/peds.2013-3775] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Our objective was to conduct a rigorous, structured process to create a new model of well-child care (WCC) in collaboration with a multisite community health center and 2 small, independent practices serving predominantly Medicaid-insured children. Working groups of clinicians, staff, and parents (called "Community Advisory Boards" [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate follow-up, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non-face-to-face methods (text, phone) for parent communication with the health care team are also critical to these new models of care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as well as the models developed, may be applicable to other small practices and clinics interested in practice redesign.
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Affiliation(s)
- Tumaini R. Coker
- UCLA Children’s Discovery and Innovation Institute, Mattel Children’s Hospital, and,RAND, Santa Monica, California
| | - Candice Moreno
- University of Illinois College of Medicine, Chicago, Illinois
| | - Paul G. Shekelle
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California;,RAND, Santa Monica, California;,Department of Internal Medicine, West Los Angeles VA Hospital, Los Angeles, California
| | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Paul J. Chung
- UCLA Children’s Discovery and Innovation Institute, Mattel Children’s Hospital, and,RAND, Santa Monica, California;,Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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