Implementing an Intervention to Address Social Determinants of Health in Pediatric Practices

Brief Summary

Detailed Description

The investigators prior work has focused on developing a pediatric primary care-based intervention, WE CARE (Well-child care visit, Evaluation, Community Resources, Advocacy, Referral, Education), aimed at addressing poor families' material needs - food security, employment, parental education, housing stability, household heat, and childcare - by systematically screening for these needs and referring families to existing community-based services. To date, the investigators have tested WE CARE primarily in community health centers (CHCs); their randomized controlled trial (RCT) demonstrated WE CARE's efficacy on parental receipt of community-based resources. However, over 80% of low-income children receive care from providers in traditional pediatric practices (i.e. non-CHCs). The investigators therefore will conduct a large-scale, Hybrid Type 2 effectiveness-implementation trial in eighteen pediatric practices in the US. A stepped wedge study cluster RCT design will be used to implement WE CARE in all practices using two common strategies used to integrate systems-based interventions into primary care - a previously facilitated "on-site" strategy in which content experts provide training sessions and on-going consultation; and a self-directed "web-based" method modeled after the American Academy of Pediatrics' practice transformation strategy. The proposed study's specific aims are to: 1) demonstrate the non-inferiority of the self-directed, web-based strategy for implementing WE CARE, in comparison to the facilitated on-site strategy; 2) demonstrate WE CARE's effectiveness on increasing parental receipt of community resources; and 3) assess the sustainability of WE CARE in pediatric practices. The investigators hypothesize that WE CARE will have equivalent fidelity via the two strategies. Based on prior work, the investigators hypothesize that WE CARE will significantly increase parental receipt of community resources three months post-visit compared to usual care. The investigators also expect WE CARE to be sustained 1.5-, 2-, and 2.5-years post-implementation; they expect to gather data from over 2,700 chart reviews, 2,520 parent-child dyads, and 360 providers and office staff. This proposal has significant public health implications for the delivery of primary care to low-income children.

Primary Outcomes

Secondary Outcomes

• Appropriate referrals made by providers(1.5-,2-,and 2.5- years post-implementation of WE CARE)
• Acceptability of WE CARE measured via questionnaires(Through study completion; baseline and 12-15 months into WE CARE phase at all sites)
• WE CARE survey distribution(1.5-,2-,and 2.5- years post-implementation of WE CARE)
• Family centeredness measured via the National Survey of Children's Health (2016)(3 months post-index visit)
• Care coordination measured via the National Survey of Children's Health (2016)(3 months post-index visit)
• Patient satisfaction measured via the CAHPS Clinician and Group Survey (Child)(3 months post-index visit)
• Whether Discussion of Unmet Needs (e.g., food insecurity) occurred at child's well-child care visit(Baseline at index visit)
• Appropriateness of WE CARE measured via questionnaire(Through study completion; baseline and 12-15 months into WE CARE phase at all sites)