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

Garg, Arvin; Butz, Arlene; Dworkin, Paul H.; Lewis, Rooti A.; Thompson, Richard E.; Serwint, Janet R.

doi:10.1542/peds.2007-0398

Cited by 242 publications

(269 citation statements)

References 30 publications

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“…The 15% difference between groups was thought to be clinically significant and feasible based on our previous study. 19 An intention-to-treat approach was used to compare intervention and control groups on study outcomes. Generalized mixed-model regressions were used to estimate the differences in covariates between groups and to test direct intervention effects on primary and secondary outcomes.…”

Section: Sample Size and Statistical Analysismentioning

confidence: 99%

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

et al. 2015

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OBJECTIVE: To evaluate the effect of a clinic-based screening and referral system (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education [WE CARE]) on families' receipt of community-based resources for unmet basic needs. METHODS:We conducted a cluster randomized controlled trial at 8 urban community health centers, recruiting mothers of healthy infants. In the 4 WE CARE clinics, mothers completed a self-report screening instrument that assessed needs for child care, education, employment, food security, household heat, and housing. Providers made referrals for families; staff provided requisite applications and telephoned referred mothers within 1 month. Families at the 4 control community health centers received the usual care. We analyzed the results with generalized mixed-effect models.RESULTS: Three hundred thirty-six mothers were enrolled in the study (168 per arm). The majority of families had household incomes ,$20 000 (57%), and 68% had $2 unmet basic needs. More WE CARE mothers received $1 referral at the index visit (70% vs 8%; adjusted odds ratio [aOR] = 29.6; 95% confidence interval [CI], 14.7-59.6). At the 12-month visit, more WE CARE mothers had enrolled in a new community resource (39% vs 24%; aOR = 2.1; 95% CI, 1.2-3.7). WE CARE mothers had greater odds of being employed (aOR = 44.4; 95% CI, 9.8-201.4). WE CARE children had greater odds of being in child care (aOR = 6.3; 95% CI, 1.5-26.0). WE CARE families had greater odds of receiving fuel assistance (aOR = 11.9; 95% CI, 1.7-82.9) and lower odds of being in a homeless shelter (aOR = 0.2; 95% CI, 0.1-0.9).CONCLUSIONS: Systematically screening and referring for social determinants during well child care can lead to the receipt of more community resources for families. WHAT'S KNOWN ON THIS SUBJECT:Although pediatric professional guidelines emphasize addressing a child' s social environment in the context of well child care, it remains unclear whether screening for unmet basic needs at visits increases low-income families' receipt of community-based resources. WHAT THIS STUDY ADDS:This study demonstrates that systematically screening and referring for social determinants of health during primary care can lead to the receipt of more community resources for families.

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Section: Sample Size and Statistical Analysismentioning

confidence: 99%

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

et al. 2015

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“…The WE CARE survey 78 is a brief set of questions that alerts the pediatrician to families experiencing stress related to poverty. In the policy statement "Promoting Food Security for All Children, " the AAP recommends the use of a 2-question survey that has a high sensitivity to detect food insecurity.…”

Section: Early Identifi Cation Of Families In Need Of Servicesmentioning

confidence: 99%

Poverty and Child Health in the United States

Gitterman¹,

Flanagan²,

Cotton³

et al. 2016

Pediatrics

480

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Almost half of young children in the United States live in poverty or near poverty. The American Academy of Pediatrics is committed to reducing and ultimately eliminating child poverty in the United States. Poverty and related social determinants of health can lead to adverse health outcomes in childhood and across the life course, negatively affecting physical health, socioemotional development, and educational achievement. The American Academy of Pediatrics advocates for programs and policies that have been shown to improve the quality of life and health outcomes for children and families living in poverty. With an awareness and understanding of the effects of poverty on children, pediatricians and other pediatric health practitioners in a family-centered medical home can assess the financial stability of families, link families to resources, and coordinate care with community partners. Further research, advocacy, and continuing education will improve the ability of pediatricians to address the social determinants of health when caring for children who live in poverty. Accompanying this policy statement is a technical report that describes current knowledge on child poverty and the mechanisms by which poverty influences the health and well-being of children.

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“…One example, the Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education Program, is a clinic-based screening, diagnosis, and referral program to help practices assist families living in poverty with unmet basic needs. 58 This program relies on a brief screening tool to determine areas of need and a resource book with tear-out information sheets for families. In a recently published randomized controlled trial, improvements for families were found with respect to key SDH, including adequate housing, fuel assistance, child care, and employment.…”

Section: Connecting Screening and Diagnosis To Actionmentioning

confidence: 99%

Determinants of Health and Pediatric Primary Care Practices

Beck

Tschudy²,

Coker

et al. 2016

Pediatrics

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More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of povertyrelated risks in ways that promote long-term health and well-being for children.abstract

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

Abstract: 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.

Cited by 242 publications

References 30 publications

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

Poverty and Child Health in the United States

Determinants of Health and Pediatric Primary Care Practices

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