Implementing an Intervention to Address Social Determinants of Health in Pediatric Practices
Condition: Basic Unmet Material Needs; Patient Satisfaction; Receipt of Community Resources; Provider Referrals
Study type: Interventional

Summary: 
      This research project is aimed to assess the implementation, effectiveness, and
      sustainability of a pediatric-based intervention aimed at reducing families' unmet material
      needs (food, housing, employment, childcare, household utilities, education) in pediatric
      practices throughout the United States.
    

Detailed description: 
      The investigators prior work has focused on developing a pediatric primary care-based
      intervention, WE CARE (Well-child care visit, Evaluation, Community Resources, Advocacy,
      Referral, Education), aimed at addressing poor families' material needs - food security,
      employment, parental education, housing stability, household heat, and childcare - by
      systematically screening for these needs and referring families to existing community-based
      services. To date, the investigators have tested WE CARE primarily in community health
      centers (CHCs); their randomized controlled trial (RCT) demonstrated WE CARE's efficacy on
      parental receipt of community-based resources. However, over 80% of low-income children
      receive care from providers in traditional pediatric practices (i.e. non-CHCs). The
      investigators therefore will conduct a large-scale, Hybrid Type 2
      effectiveness-implementation trial in eighteen pediatric practices in the US. A stepped wedge
      study cluster RCT design will be used to implement WE CARE in all practices using two common
      strategies used to integrate systems-based interventions into primary care - a previously
      facilitated "on-site" strategy in which content experts provide training sessions and
      on-going consultation; and a self-directed "web-based" method modeled after the American
      Academy of Pediatrics' practice transformation strategy. The proposed study's specific aims
      are to: 1) demonstrate the non-inferiority of the self-directed, web-based strategy for
      implementing WE CARE, in comparison to the facilitated on-site strategy; 2) demonstrate WE
      CARE's effectiveness on increasing parental receipt of community resources; and 3) assess the
      sustainability of WE CARE in pediatric practices. The investigators hypothesize that WE CARE
      will have equivalent fidelity via the two strategies. Based on prior work, the investigators
      hypothesize that WE CARE will significantly increase parental receipt of community resources
      three months post-visit compared to usual care. The investigators also expect WE CARE to be
      sustained 1.5-, 2-, and 2.5-years post-implementation; they expect to gather data from over
      2,700 chart reviews, 2,520 parent-child dyads, and 360 providers and office staff. This
      proposal has significant public health implications for the delivery of primary care to
      low-income children.
    

Intervention name(s): WE CARE
Intervention type(s): Behavioral
Intervention description(s): The WE CARE (Well-child care visit, Evaluation, Community Resources, Advocacy, Referral, Education) survey consists of 12 questions used to identify six unmet material needs (education, employment, food security, housing, childcare, household utilities). It will be administered at health supervision visits during the WE CARE phase at each study site. The Family Resource Book will contain resource information sheets for each of these needs listing available community resources. A physician champion will conduct regular booster sessions every 4 months and train new providers should there be staff turnover.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Screening
Keywords: WE CARE; Pediatric practices