Improving the Management of Family Psychosocial Problems at Low-Income Children's Well-Child Care Visits: The WE CARE Project

Johns Hopkins University, Baltimore, Maryland, United States
PEDIATRICS (Impact Factor: 5.47). 10/2007; 120(3):547-58. DOI: 10.1542/peds.2007-0398
Source: PubMed


Our goal was to evaluate the feasibility and impact of an intervention on the management of family psychosocial topics at well-child care visits at a medical home for low-income children.
A randomized, controlled trial of a 10-item self-report psychosocial screening instrument was conducted at an urban hospital-based pediatric clinic. Pediatric residents and parents were randomly assigned to either the intervention or control group. During a 12-week period, parents of children aged 2 months to 10 years presenting for a well-child care visit were enrolled. The intervention components included provider training, administration of the family psychosocial screening tool to parents before the visit, and provider access to a resource book that contained community resources. Parent outcomes were obtained from postvisit and 1-month interviews, and from medical chart review. Provider outcomes were obtained from a self-administered questionnaire collected after the study.
Two hundred parents and 45 residents were enrolled. Compared with the control group, parents in the intervention group discussed a significantly greater number of family psychosocial topics (2.9 vs 1.8) with their resident provider and had fewer unmet desires for discussion (0.46 vs 1.41). More parents in the intervention group received at least 1 referral (51.0% vs 11.6%), most often for employment (21.9%), graduate equivalent degree programs (15.3%), and smoking-cessation classes (14.6%). After controlling for child age, Medicaid status, race, educational status, and food stamps, intervention parents at 1 month had greater odds of having contacted a community resource. The majority of residents in the intervention group reported that the survey instrument did not slow the visit; 54% reported that it added <2 minutes to the visit.
Brief family psychosocial screening is feasible in pediatric practice. Screening and provider training may lead to greater discussion of topics and contact of community family support resources by parents.

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Available from: Richard E Thompson, Jun 03, 2014
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    • "Seven ( Furbee 1998; Larkin 1999; Knight 2000; Bonds 2006; Halpern 2009; Hewitt 2011; Kapur 2011) did not meet criteria as randomised or quasi-randomised trials. In four studies (Coonrod 2000; Brienza 2005; Fernandez-Alonso 2006; Garg 2007), data on women were not provided or could not be separated out. In Chen 2007, Ernst 2007 and Rickert 2009 there was no usual care comparison, while in Hollander 2001, screening results were passed on to the healthcare professional in both the usual care as well as the intervention group. "
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