Targeted Inpatient Navigation to Improve Care for Minority Children and Families

Study Overview
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Brief Summary
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The overall goal of this research is to evaluate a new program designed to address basic human needs, create a safe and supportive environment for families, and help families build skills and confidence for navigating the health care system. Specifically, we aim to pilot test the feasibility and acceptability of the Targeted Inpatient Navigation (TNav) program for families of low income, minority hospitalized children.

Official Title
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Targeted Inpatient Navigation to Improve Care for Minority Children and Families

Conditions
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Hospitalized Children

Intervention / Treatment
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* Behavioral: Family Bridge Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Caregiver ≥18 years of age, with a hospitalized child <18 years old Preferred language of English, Spanish and Somali child with Medicaid insurance or no insurance child with self-reported (or parent-reported) minority race/ethnicity within 3 days of admission/ transfer to the medical unit on a general medicine service of a resident team Exclusion Criteria: Admission for suspected child abuse Involvement of Child Protective Services at time of admission Admission for primary mental health condition, including intentional ingestion and eating disorder Family already enrolled in longer-term navigation services

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Family Bridge Program<br>Families receive Family Bridge Program services which include orientation to the hospital, concrete needs assessment, communication preferences assessment, communication coaching, follow-up during the hospital stay, and a follow-up phone call after discharge. | Behavioral: Family Bridge Program<br>* Families receive Family Bridge Program services which include orientation to the hospital, concrete needs assessment, communication preferences assessment, communication coaching, follow-up during the hospital stay, and a follow-up phone call after discharge.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Program acceptability to caregivers--qualitative | Program acceptability will be determined qualitatively, on the basis of thematic content analysis of semi-structured interviews with enrolled caregivers | 4-6 weeks after discharge | 
| Program feasibility | Ability to deliver program elements as planned, calculated as the number of Family Bridge services delivered to a family divided by the services available to that family. | Calculated for each family after program involvement is complete, generally 1 week after discharge. | 
| Program acceptability to providers--qualitative | Program acceptability will be determined qualitatively, on the basis of thematic content analysis of semi-structured interviews with the doctors, nurses, social workers and care coordinators who were involved in their hospital care. | Once per month, every month that they care for an enrolled family, up to 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cultural Distance Scale | 4 items measuring perceived similarity or difference in norms and values between family and medical providers. Each of the 4 items is scored on a Likert scale from 1 to 6, with higher values reflecting greater difference. The total scale score is the average of the 4 responses, on a scale from 1 to 6. | Enrollment and 2-4 weeks after discharge. | 
| Barriers to Care Questionnaire | 20 items measuring perceived barriers to medical care, with 4 sub-scales, each scored and reported separately: System as a whole, Skills barriers, Expectation barriers, and Knowledge barriers. Each subscale was scored 0-100, with higher scores indicating greater barriers. | Enrollment and 2-4 weeks after discharge. | 
| Perceived Efficacy in Patient-Physician Interactions (PEPPI) | 10-item tool measuring understanding of and ability to interact with health professionals and organizations. | Enrollment and 2-4 weeks after discharge. | 
| Perceived Stress Scale-short form | 4 items, scored from 0 (Never) to 4 (Very Often), related to perceived stress and control over one's life. Responses are summed for a total score from 0 to 16, with higher scores reflecting greater stress. | Enrollment and 2-4 weeks after discharge. | 
| Local system navigation | 9 items assessing familiarity with navigating the local health care system. | Enrollment and 2-4 weeks after discharge. | 
| Communication--Pediatric H-CAHPS | 9 items assessing quality of communication from doctors and nurses, including at discharge. | 2-4 weeks after discharge. | 
| Partnership--Pediatric H-CAHPS | 3 items assessing provider-family partnership. | 2-4 weeks after discharge. | 
| Health care transition questions | 10 items assessing quality of transition and comfort and understanding of home care. | 2-4 weeks after discharge. | 
| Unmet need for navigation | 7 items to determine whether family's needs were identified and met during hospitalization | 2-4 weeks after discharge. |