Primary care, as currently designed, is not meeting the needs of children in low-income communities. New structures and process of care have the potential to enhance the receipt of high quality care, and improve outcomes in child health and well-being.
Structural changes may include utilizing non-physician staff to provide health services, using electronic formats for health assessments and other health services, and creating new and innovative process of care. Current projects include:
Using Telehealth to Deliver Developmental, Behavioral, and Mental Health Services in Primary Care Settings for Children in Underserved Areas
Funder: PCORI, CCF
Principal Investigator: Tumaini R. Coker, MD, MBA, PI
In partnership with a multisite, Los Angeles–area community clinic consortium, Northeast Valley Health Corporation (NEVHC) and their mental health clinic partners (Child and Family Guidance Center and Child and Family Center), we will use telehealth to increase access to mental and behavioral health services among low-income, publicly insured children. During Project Year 1, we conducted interviews with parents, clinicians, and staff at NEVHC and two community mental health clinics to assess their perspectives on the referral and delivery system for child mental and behavioral health services and on a potential telehealth-based system for providing mental and behavioral health specialty care in primary care settings to children ages 5–12. These data were used in a stakeholder-engaged process to create a telehealth-based system for child mental and behavioral health services that can be integrated into primary care settings. During Project Years 2–3, we will compare this customized telehealth-based system to the usual in-person referral system at NEVHC in 400 children ages 5–12 who require mental and behavioral health specialty referral. This study will examine whether a telehealth mental and behavioral health delivery model can be an effective, efficient, and family-centered way to increase access to mental and behavioral health services to children in low-income communities.
Community mental health clinic parent welcome videos were created in English and Spanish for this research; they are available on our Videos page.
Well-Child Care (WCC) visits for child preventive health care during the first three years of life are critical because they may be the only opportunity before a child reaches preschool to identify and address important social, developmental, behavioral, and health issues that could have significant impact and long-lasting effects on children’s lives as adults. Unfortunately, this opportunity is often missed for children in low-income communities. We used a rigorous, structured community-partnered approach to develop a new, innovative model of WCC delivery to meet the needs of children in low-income communities.
Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT)
PARENT is a team-based approach to care 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.
In an initial pilot randomized controlled trial of PARENT among 251 low-income families in two urban area pediatric practices, we found strong and consistent intervention effects on the quality of preventive care provided to families, and on reducing emergency department (ED) utilization. A larger trial of PARENT with multiple clinics is needed to position PARENT as an evidence-based, financially sustainable model for WCC delivery that can be implemented by practices and clinics nationwide.
In this current study, we propose to conduct a large, multi-site trial of PARENT to: