What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Schor called on pediatricians to rethink well-child care. Gaps exist between traditional wellchild care and contemporary needs and pressures. A key, but largely missing, perspective in the rethinking of discussions has been that of parents. WHAT THIS STUDY ADDS:In this qualitative study, we asked parents to address several core issues including why they attend well-child care visits, the aspects of care they find most valuable, and what changes could enhance the well-child experience.abstract OBJECTIVE: The content and systems surrounding well-child care have received increasing attention, and some propose that it is time to rethink both the delivery structure and central themes of well-child visits. A key, but largely missing perspective in these discussions has been that of parents, whose experiences and expectations are central to developing approaches responsive to family needs. In this study, we asked parents to address several core issues: why they attend wellchild visits; aspects of well-child care that they find most valuable; and changes that could enhance the well-child care experience. METHODS: Twenty focus groups with parents (n ϭ 131 [91% mothers])were conducted by using a semistructured interview guide. Verbatim transcripts were coded for key words, concepts, and recurrent themes. RESULTS:Primary reasons for visit attendance included reassurance (child and parent) and an opportunity to discuss parent priorities. Families valued an ongoing relationship with 1 clinician who was childfocused and respected parental expertise, but continuity of provider was not an option for all participants. Suggestions for enhancement included improved promotion of well-child care, greater emphasis on development and behavior, and expanded options for information exchange. CONCLUSIONS:As the consumers of care, it is critical to understand parents' needs and desires as changes to the content and process of well-child care are considered. Taking into account the multifaceted perspectives of families suggests both challenges and opportunities for the rethinking discussion. Pediatrics 2009;124:858-865

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

“…Although parents do not want to spend more time in the waiting or examination rooms waiting for the visit to begin, parents have expressed a desire to spend more time in visits getting their needs addressed, particularly psychosocial, behavioral, and developmental needs. 19,34 Our findings from previous WCC redesign studies suggest that a WCC model that is less reliant on the physician for routine WCC services is acceptable to parents, payers, and pediatricians. 16,[18][19][20] With the advent of retail-based clinics and Internet-based care, 35 a greater burden of chronic disease during childhood, 36 and an increasing need for chronic care management, 37 primary care pediatrics may need to adapt to a more specialty-based model similar to primary care pediatrics in many other developed nations.…”

“…Our findings may not be applicable to practices that do not serve low-income families, because parent perspectives on WCC redesign differ for samples of higher-income parents. 34 Finally, we conducted a preliminary break-even analysis for the CHC but do not have actual cost or utilization data.…”

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

“…92 A parallel survey of parents also noted the limited communication that exists between pediatric practices and community-based services, such as Supplemental Nutrition Program for Women, Infants, and Children; child care providers; and schools. 93 Perhaps most important, both groups agreed that pediatricians cannot be expected to meet all of a child' s needs. This challenge is further complicated by the marked variability in quality among community-based services that are available-ranging from evidencebased interventions that clearly improve child outcomes to programs that appear to have only marginal effects or no measurable impacts.…”

Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health

“…Rather than continuing the current trend of "doing more with less," as pediatricians take on a wide range of additional responsibilities, payment reforms should reflect the value of pediatricians' time and knowledge, as well as the importance of a pediatrician-led medical home serving as a focal point for the reduction of toxic stress and for the support of child and family resiliency. This additional work and the reprioritization of efforts should reflect pediatricians' interest in preventive care that is more developmentally relevant, 32 parents' desire for a greater emphasis on their child' s emerging skills and behavior, 33 the commitment to team-based services within the pediatric medical home, 28 and the growing evidence base that early developmental interventions can have significant effects on life-course trajectories. 34 As the most logical candidate for a universal platform to promote healthy development and optimal life course trajectories, the pediatric medical home has become the focus of both increasing expectations and formidable challenges.…”