The current models of primary care don’t meet the needs of children in low-income communities. New structures, formats and processes could improve these children’s health and well-being by providing high quality care that more effectively addresses the multitude of needs among families in low-income communities. The Innovation in Child Healthcare Delivery Lab is working to improve care through research that includes:

Investigating a Parent Coach Model for Well-Child Visits

Well-child care (WCC) visits during a child’s first three years are a critical opportunity to identify and address social, developmental, behavioral and health issues. Unfortunately, many children in low-income communities miss this opportunity and suffer long-term problems as a result. We partnered with community organizations to develop a WCC model that could help overcome this.

Our model, called Parent-Focused Redesign for Encounters, Newborns to Toddlers (PARENT), is a team-based approach that relies on a health educator/parent coach to provide the bulk of WCC services, address the needs of families in low-income communities and reduce the reliance on clinicians to provide all WCC services.

Our randomized, controlled trial found that families who participated in the PARENT model consistently received higher-quality preventive care and made significantly fewer emergency department visits. Now we are leading a larger, NIH-funded study that implements PARENT in multiple clinics. The goal is to assess whether PARENT is an effective, financially sustainable model that can be implemented by practices and clinics nationwide.

This research was featured in an article in The Wall Street Journal. The research was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH/NICHD), the Health Resources and Services Administration (HRSA) and the UCLA Kaiser Permanente Center for Health Equity. The new, large cluster randomized controlled trial is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH/NICHD) (R01HD088586).

Using Telehealth to Improve Primary Care Delivery

We are partnering with a large consortium of community clinics in Los Angeles, called the Northeast Valley Health Corporation (NEVHC), and their mental health clinic partners (the Child and Family Guidance Center [CFGC] and the Child and Family Center [CFC]) to use telehealth to increase access to mental and behavioral health services for low-income, publicly insured children. This project started by interviewing parents, clinicians and staff at NEVHC to capture their perspectives on how mental and behavioral health services are referred and delivered. The interviews also gathered perspectives on the mental and behavioral health referral process and parent experiences in accessing care.

Guided by stakeholders, we used these data to create a telehealth-based referral system for child mental and behavioral health services that can be integrated into primary care settings. Now we are studying how this system compares to the in-person referral system at NEVHC. Our study examines whether a telehealth-based model can be an effective, efficient and family-centered way to increase access to mental and behavioral health services to children in low-income communities.

As part of this project, we created videos to welcome parents to community mental health clinics. These videos are available in English (CFC video, CFGC video) and Spanish (CFC video, CFGC video).

This research is funded by the Patient-Centered Outcomes Research Institute and the California Community Foundation (IH-12-11-4168).

Using Text Messaging to Help Low-Income Families Cope With Asthma

We are studying an intervention that uses text messaging to help low-income parents communicate their child’s asthma care needs to primary care providers. The goal is to improve asthma health outcomes by making it easier for parents to understand, implement and manage asthma care, in partnership with their primary care doctor. If this intervention is effective, it could be applied to many other chronic diseases and reduce the health disparities faced by children in low-income families.

The intervention, called Text2Breathe (T2B), consists of a personalized, interactive text-messaging program that includes asthma and health communication education. T2B also incorporates follow-up reminders for scheduling asthma care appointments, annual flu vaccinations and medication refills. 

Parents learn an easy-to-use communication strategy to use at visits with their child’s doctor. This strategy revolves around the “three S’s”: sharing information and concerns; seeking information about diagnosis and asthma care plan; and “saying it back” for mutual verification. Periodic text messages reinforce this strategy.

This project is conducted in partnership with Seattle Children’s Emergency Department and the Mary Bridge Children’s Hospital and Health Network emergency departments. 

This research is funded by the National Institute on Minority Health and Health Disparities (NIH/NIMHD; R01MD007740).