Well-Child Care Redesign: A Mixed Methods Analysis of Parent Experiences in the PARENT Trial

Mimila, Naomi A.; Elliott, Marc N.; Bethell, Christina; Chacon, Sandra; Biely, Christopher; Contreras, Sandra; Chavis, Toni; Bruno, Yovana; Moss, Tanesha; Coker, Tumaini R.

doi:10.1016/j.acap.2017.02.004

Cited by 15 publications

(7 citation statements)

References 24 publications

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“…1,30 This idea is consistent with recent research suggesting that screening questionnaires can play an important role in shared decision-making, especially in regard to improving communication about developmental issues and in enhancing engagement between pediatric practitioners and parents. [31][32][33] This study's results suggest trade-offs among screening questionnaires, but no questionnaire was found to be clearly superior. For example, the PEDS displayed some of the lowest diagnostic odds ratios, yet it had the highest sensitivity to severe delays.…”

Section: Discussionmentioning

confidence: 72%

“…Investigators have long noted that screening instruments’ usefulness depends not only on their accuracy but also on their ability to inform case conceptualization and medical decision-making . This idea is consistent with recent research suggesting that screening questionnaires can play an important role in shared decision-making, especially in regard to improving communication about developmental issues and in enhancing engagement between pediatric practitioners and parents …”

Section: Discussionmentioning

confidence: 99%

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Comparative Accuracy of Developmental Screening Questionnaires

et al. 2020

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screening is widely recommended, yet studies of the accuracy of commonly used questionnaires reveal mixed results, and previous comparisons of these questionnaires are hampered by important methodological differences across studies.OBJECTIVE To compare the accuracy of 3 developmental screening instruments as standardized tests of developmental status. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional diagnostic accuracy study recruited consecutive parents in waiting rooms at 10 pediatric primary care offices in eastern Massachusetts between October 1, 2013, and January 31, 2017. Parents were included if they were sufficiently literate in the English or Spanish language to complete a packet of screening questionnaires and if their child was of eligible age. Parents completed all questionnaires in counterbalanced order. Participants who screened positive on any questionnaire plus 10% of those who screened negative on all questionnaires (chosen at random) were invited to complete developmental testing. Analyses were weighted for sampling and nonresponse and were conducted from October 1, 2013, to January 31, 2017. EXPOSURES The 3 screening instruments used were the Ages & Stages Questionnaire, Third Edition (ASQ-3); Parents' Evaluation of Developmental Status (PEDS); and Survey of Well-being of Young Children (SWYC): Milestones. MAIN OUTCOMES AND MEASURES Reference tests administered were Bayley Scales of Infant and Toddler Development, Third Edition, for children aged 0 to 42 months, and Differential Ability Scales, Second Edition, for older children. Age-standardized scores were used as indicators of mild (80-89), moderate (70-79), or severe (<70) delays.RESULTS A total of 1495 families of children aged 9 months to 5.5 years participated. The mean (SD) age of the children at enrollment was 2.6 (1.3) years, and 779 (52.1%) were male. Parent respondents were primarily female (1325 [88.7%]), with a mean (SD) age of 33.4 (6.3) years. Of the 20.5% to 29.0% of children with a positive score on each questionnaire, 35% to 60% also received a positive score on a second questionnaire, demonstrating moderate co-occurrence. Among younger children (<42 months), the specificity of the ASQ-3 (89.4%; 95% CI, 85.9%-92.1%) and SWYC Milestones (89.0%; 95% CI, 86.1%-91.4%) was higher than that of the PEDS (79.6%; 95% CI, 75.7%-83.1%; P < .001 and P = .002, respectively), but differences in sensitivity were not statistically significant. Among older children (43-66 months), specificity of the ASQ-3 (92.1%; 95% CI, 85.1%-95.9%) was higher than that of the SWYC Milestones (70.7%; 95% CI, 60.9%-78.8%) and the PEDS (73.7%; 95% CI, 64.3%-81.3%; P < .001), but sensitivity to mild delays of the SWYC Milestones (54.8%; 95% CI, 38.1%-70.4%) and of the PEDS (61.8%; 95% CI, 43.1%-77.5%) was higher than that of the ASQ-3 (23.5%; 95% CI, 9.0%-48.8%; P = .012 and P = .002, respectively). Sensitivity exceeded 70% only with respect to severe delays, with 73.7% (95% CI, 50.1%-88.6%) for the SWYC Milestones among younger children, 78.9% (95% CI, 55...

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Comparative Accuracy of Developmental Screening Questionnaires

et al. 2020

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“…Parent-Focused Redesign for Encounters, Newborns to Toddlers (PARENT) is an evidence-based model of WCC that was previously developed for children aged 0-3 years in low-income families, to ensure that when families attend a WCC visit, their preventive care needs are met (14)(15)(16). PARENT is a team-based approach where a trained CHW in the role of a health educator (a "parent coach") is added to the clinical care team and is responsible for providing anticipatory guidance, social needs screening and referral, and developmental or behavioral monitoring, screening, and guidance at each WCC visit.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a community health worker-focused team-based model of care: What modifications do clinics make?

Guerra

Ortiz

Liljenquist

et al. 2023

Front. Health Serv.

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BackgroundTeam-based care offers potential for integrating non-clinicians, such as community health workers (CHWs), into the primary care team to ensure that patients and families receive culturally relevant care to address their physical, social, and behavioral health and wellness needs. We describe how two federally qualified health center (FQHC) organizations adapted an evidence-based, team-based model of well-child care (WCC) designed to ensure that the parents of young children, aged 0–3, have their comprehensive preventive care needs met at WCC visits.MethodsEach FQHC formed a Project Working Group composed of clinicians, staff, and parents to determine what adaptations to make in the process of implementation of PARENT (Parent-Focused Redesign for Encounters, Newborns to Toddlers), a team-based care intervention that uses a CHW in the role of a preventive care coach. We use the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to chronicle the various intervention modifications and the adaptation process, focusing on when and how modifications occurred, whether it was planned or unplanned, and the reasons and goals for the modification.ResultsThe Project Working Groups adapted several elements of the intervention in response to clinic priorities, workflow, staffing, space, and population need. Modifications were planned and proactive, and were made at the organization, clinic, and individual provider level. Modification decisions were made by the Project Working Group and operationalized by the Project Leadership Team. Examples of modifications include the following: (1) changing the parent coach educational requirement from a Master's degree to a bachelor's degree or equivalent experience to reflect the needs of the coach role; (2) the use of FQHC-specific templates for the coach's documentation of the pre-visit screening in the electronic health record; and (3) the use of electronic social needs referral tools to help the coach track and follow up on social need referrals. The modifications did not change the core elements (i.e., parent coach provision of preventive care services) or intervention goals.ConclusionsFor clinics implementing team-based care interventions, the engagement of key clinical stakeholders early and often in the intervention adaptation and implementation process, and planning for intervention modifications at both at an organizational level and at a clinical level are critical for local implementation.

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“…To address the gaps in current WCC, we partnered with federally qualified health centers (FQHCs) to develop a new model of WCC to meet the needs of children in low-income communities. The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention is a team-based approach to WCC relying 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 [ 17 - 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…In an initial pilot RCT of PARENT among 251 low-income families in 2 urban areas, we found strong and consistent intervention effects on the quality of preventive care provided to families and on reducing ED use ( Table 1 ) [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

A Parent Coach–Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial

Hurst¹,

Liljenquist²,

Lowry³

et al. 2021

JMIR Res Protoc

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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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Well-Child Care Redesign: A Mixed Methods Analysis of Parent Experiences in the PARENT Trial

Cited by 15 publications

References 24 publications

Comparative Accuracy of Developmental Screening Questionnaires

Comparative Accuracy of Developmental Screening Questionnaires

Implementation of a community health worker-focused team-based model of care: What modifications do clinics make?

A Parent Coach–Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial

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