CIN001-HeadStart Navigator Intervention

Headstart (HS) is a pipeline for early school success for low-income children aged 3-5 years, and provides health promotion services such as developmental monitoring to promote school readiness. In 2014-2015 Hamilton County Headstart (HCHS) identified 968 of 2987 preschoolers (32%) with developmental concern, with 251 (26%) identified as "severe concern" necessitating developmental testing. Yet, follow-through with testing did not occur for 53 high-risk preschoolers (21%), and only 451 (47%) followed-through when some developmental concern was identified. Those less likely to follow-through were African American or Hispanic, lived in families of 3 or more, or had asthma. That race and ethnicity predict insufficient follow-through is not surprising; cultural and economic factors are known barriers to earlier diagnosis of children with developmental disabilities (DD), resulting in 2 year lags in obtaining DD diagnoses among African American, Hispanic and low-income children and placing them at risk for worse long-term prognosis. Diagnostic disparities are also grounded in the social factors of poorer health care access, caregiver distrust of health systems, knowledge deficits, and stigma about disability. One mechanism thought to contribute to the diagnostic delays is caregiver postponement in obtaining developmental assessments due to these collective factors. Given that all HS children are low-income and a majority are African American or Hispanic, HS preschoolers are likely to face barriers to early identification of DD and subsequently kindergarten readiness. An intervention that addresses the salient barriers to developmental assessment for HS preschoolers could advance pre-academic abilities and promote access to earlier recognition and treatment of DD, leading to improved health outcomes.

Patient navigator programs have been effective interventions for vulnerable populations to improve health care access, increase treatment adherence, enhance trust in health care systems, and reduce health care costs. Despite these findings, investigations into peer-based navigation interventions for families of children with inferior health outcomes have mostly been program evaluations or unpublished clinical trials. A promising study in Developmental and Behavioral Pediatrics (DBP) on family navigators (FN) for children referred from primary care for evaluation of DD is examining family quality of life outcomes prior to and after DD diagnoses, and has shown preliminary success in developing and training FNs. A FN intervention that is culturally-adapted to promote caregiver follow-through, and undergirded by HS's mission of kindergarten readiness may effectively increase caregiver adherence to developmental testing in HS. The goal of this study is to refine and pilot test a FN intervention that is informed by HS caregivers, staff and primary care providers (PCP), grounded in the HS community, and executed by peer-to-peer navigators to improve adherence with developmental testing in high-risk preschoolers. This study is the final year of a research program that will focus on tailoring the elements of a community-based (Head Start (HS) Family Navigator (FN) intervention for high risk children with developmental concerns in order to improve access to developmental testing. This study will be conducted over a 1 year period with the specific aim outlined below.

The study titled: Prototype of a Head Start Navigator Intervention for Child Developmental Testing (IRB#2016-4253) was conducted to develop a community-based family navigator intervention for preschoolers identified in HS as high-risk for developmental delay. Focus groups were conducted with caregivers, teachers and primary care providers (PCPs) to understand the barriers and facilitators to follow-through with developmental testing. The prototype was tailored to the thematic focus group findings, cultural and risk factors previously identified, and results of an updated analysis of predictors of poor follow-through of developmental assessments from HCHS academic year 2015-2016 (IRB# 2016-4253). Findings confirmed that primary care and Head Start operate in silos regarding developmental screening and follow-through for at-risk children. Facilitating factors to caregiver follow-through were identified as: building relationships, increasing resource knowledge, and addressing denial/stigma of disability. Findings substantiated that caregivers needed assistance with navigating developmental testing, and valued its delivery using a peer-to-peer approach that was culturally-matched. The intervention was adapted from the crucial components necessary for a successful Family Navigator training program and delivery of the intervention including elements of frequency, duration and intensity that were also confirmed by the findings.

Materials and Methods

Study Purpose: