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Publication Q&A: Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children: A Randomized Clinical Trial

April 2023 – In a recent publication in the Journal of the American Medical Association (JAMA), Dr. Tumaini Coker and other collaborators from Seattle Children’s Center for Child Health, Behavior and Development share insights into the work underway that  explores the benefits of a team-based approach in early childhood well-care visits.

Tumaini R. Coker, Kendra Liljenquist, Sarah J. Lowry, Kevin Fiscella, Marcia R. Weaver, Janette Ortiz, Rachel LaFontaine, Javier Silva, Taylor Salaguinto, Gina Johnson, Lisa Friesema, Lorena Porras-Javier, Laura J. Sotelo Guerra, Peter G. Szilagyi

Read the full article in JAMA.

What are the significant findings in this paper?

Well-child care visits during a child’s first three years presents an important opportunity to address social, developmental, behavioral and health issues. Pediatricians recommend that families make as many as 10 well-child care visits during this period; however, families living in low-income communities have multiple needs that are not always met in a typical 15-minute well child care visit.

The Parent-Focused Redesign for Encounters, Newborns to Toddlers (PARENT) model of well-child care is a team-based approach to well-child care visits that was tested in a trial including ten different clinics, in which 5 clinics were randomly assigned to implement the model. The aim of this trial was to test the success of implementing a health educator/parent coach to help provide relationship-based, preventive care services to families, and reduce the reliance on the typical 15 minutes with a pediatrician to meet all of a families’ early childhood health needs.

This latest publication in JAMA shares findings from this trial, showing that parents in the intervention clinics received more guidance and education on important topics related to preventive health, such as child development and behavior and safety, and more screening for psychosocial and household social needs. They also were more likely to attend all of the recommended preventive care visits.  

What does this research tell us that we didn’t know before?

Well-child care visits are typically provided by a pediatrician. In national guidelines for preventive care in early childhood, parents should receive education and guidance, and screening and community resources for social needs at these visits.

Using the PARENT intervention, this study integrated community health workers in well-child care visits during early childhood, working as a team with the pediatrician, to provide these preventive care services to families. We found that by adding the community health worker to the team, parents received more preventive care services, found their visits to be more helpful and attended more of their well-child care visits. No other randomized trial has evaluated outcomes of utilizing a community health worker (without advanced degrees or licensure) to provide these well-child care services in team-based care.

What are the broad implications of this research?

This research could lead to better ways to ensure that clinics meet the preventive care needs of families, particularly those with low-incomes who have a range of education, guidance and social needs to cover at early childhood well-child care visits.

Seattle Children’s contributing authors:

  • Tumaini R. Coker
  • Kendra Liljenquist
  • Sarah J. Lowry
  • Taylor Salaguinto
  • Laura J. Sotelo Guerra