A Conceptual Framework for Group Well-Child Care: A Tool to Guide Implementation, Evaluation, and Research

Abstract

Objective To use scoping review methods to construct a conceptual framework based on current evidence of group wellchild care to guide future practice and research. Methods We conducted a scoping review using Arksey and O'Malley's (2005) six stages. We used constructs from the Consolidated Framework for Implementation Research and the quadruple aim of health care improvement to guide the construction of the conceptual framework. ResultsThe resulting conceptual framework is a synthesis of the key concepts of group well-child care, beginning with a call for a system redesign of well-child care to improve outcomes while acknowledging the theoretical antecedents structuring the rationale that supports the model. Inputs of group well-child care include health systems contexts; administration/ logistics; clinical setting; group care clinic team; community/patient population; and curriculum development and training. The core components of group well-child care included structure (e.g., group size, facilitators), content (e.g., health assessments, service linkages). and process (e.g., interactive learning and community building). We found clinical outcomes in all four dimensions of the quadruple aim of healthcare. Conclusion Our conceptual framework can guide model implementation and identifies several outcomes that can be used to harmonize model evaluation and research. Future research and practice can use the conceptual framework as a tool to standardize model implementation and evaluation and generate evidence to inform future healthcare policy and practice.

Group Well Child Care for Mothers with Opioid Use Disorder: Framework for Implementation

“…The potential barriers raised by our participants align with previously reported financial, structural, and procedural factors that have been shown to be important for group WCC implementation (Gresh et al, 2023 ). As participants have noted, staffing, training, space, and equipment are required for group WCC, underscoring the importance of a supportive policy environment and commensurate funding streams (Gresh et al, 2023 ; Connor et al, 2018 ).…”

“…The potential barriers raised by our participants align with previously reported financial, structural, and procedural factors that have been shown to be important for group WCC implementation (Gresh et al, 2023 ). As participants have noted, staffing, training, space, and equipment are required for group WCC, underscoring the importance of a supportive policy environment and commensurate funding streams (Gresh et al, 2023 ; Connor et al, 2018 ). Examples of potential financial support include the federally-funded Healthy Start initiative, state-level funds, and in-kind service grants from Centering Healthcare Institute (National Healthy Start Association, 2023 ; CHI, 2023 ).…”

“…Although most mothers in our sample reported positive experiences with group formatted care, concerns about privacy and group dynamics were raised by study participants. As recommended for all group WCC programs, we plan to use a large room with enough physical space to accommodate group activities as well as semi-private discussions (Gresh et al, 2023 ). Interdisciplinary co-facilitation is also generally recommended to assist the primary clinician in navigating group dynamics (Griswold & Walker, 2021 ; Marchel et al, 2015 ).…”

“…In order to ensure that group WCC meets the comprehensive care needs of each family, we will develop a health assessment questionnaire for group visits to facilitate history taking and identify specific concerns, as is common in other group WCC programs (Gresh et al, 2023 ). We will also tailor the content of group discussions to reflect parental priorities for anticipatory guidance (Goyal et al, 2023 ).…”

“…Prior studies suggest enhanced family resilience and interconnectedness, improved visit attendance, and increased satisfaction with care (Fenick et al, 2020 ; Irigoyen et al, 2021 ; Oldfield et al, 2020 ). Despite these benefits, group WCC remains underutilized, with numerous logistical challenges that include cost, space, and scheduling (Gaskin et al, 2021 ; Gresh et al, 2023 ).…”