Reducing Socioeconomic Disparities in Health at Pediatric Visits
Condition: Asthma; Obesity; Health Care Utilization; Health Care Disparities; Basic Unmet Social Needs; Blood Pressure; Child Maltreatment; Child Development
Study type: Interventional

Summary: 
      This research project is aimed to assess the effectiveness and impact of a pediatric-based
      intervention aimed at reducing low-income families' unmet material needs (food, housing,
      employment, childcare, household heat, education and learning the English language ) on child
      health.
    

Detailed description: 
      This project builds upon the PI's prior studies including a recently completed cluster
      randomized controlled trial (RCT) at community health centers in Boston, which demonstrated a
      positive impact on provider referrals, discussion, and family receipt of resources.

      This study will specifically test the effectiveness of a further strengthened intervention
      "WE CARE 2.0" on provider referrals and family receipt of resources, along with its impact on
      child health, health care utilization, and developmental outcomes. Finally, we will gather
      information from stakeholders at the health centers in order to learn more about the
      facilitators and barriers to implementation of the model.

      The study will take place at six community health centers in the Greater Boston area. The
      centers will be randomized to either an intervention or control site. Data will be collected
      on referrals, receipt of resources, and child outcomes from the child's electronic medical
      record (EMR) from birth to age 3. Focus groups will be used to gather implementation data
      from intervention health center personnel.

      The WE CARE 2.0 intervention consists of: 1) WE CARE surveys which parents complete prior to
      their child's well-child visits; 2) information technology (IT) generated provider referrals
      which providers use to provide families with resource information sheets; 3) peer patient
      navigators who assist families in connecting to available resources and updating providers;
      and 4) training sessions for providers and office staff.

      Families attending the control health centers will receive standard of care. Of note, since
      the health centers share a common EMR and for ethical reasons, control sites will have access
      to the IT generated referral mechanism.
    

Intervention name(s): WE CARE survey; WE CARE Community Resource Handout; Patient Navigator
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The WE CARE survey, consists of 14 questions used to identify seven unmet material needs (education, employment, food security, housing, childcare, household heat, language). The survey will be administered with patient's developmental screening forms at all health supervision visits from birth to two years of age. The office staff will instruct parents to give the WE CARE survey, along with the developmental screening tool, to their child's provider at the visit.; Providers will be trained to review the WE CARE survey at health supervision visits and generate referrals thru the EMR. Specifically, they will receive a one-hour teaching session one week prior to the study implementation. The goals for the session will include providing an overview of pediatric practice guidelines, introducing the WE CARE survey, reviewing the referral process, and discussing the role of peer patient navigators. Study staff will conduct periodic booster sessions; study staff will also train new providers should there be staff turnover; The peer patient navigator will offer guidance to families with accessing community resources. They will be available at least .5 days per week at intervention health centers to meet with families and offer guidance as well as be available via a hotline number. The navigator will speak with families and offer guidance on community resources and offer assistance with completing applications. In addition, they will offer to schedule and, if desired, accompany parents to the agencies. Interpreter services will be utilized at the health centers in case the navigator does not speak the parent's language. The navigator will also place an update note in the EMR within 1-month post-visit and one week after any contact with families.
Other intervention name(s): Resource Referral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: community resource; well-child care visit; low-income