Urban, Low-Income, African American Well-Child Care: Comparison of Parent and Healthcare Provider Experiences and Expectations

Background. Reading skills are critical to children's success in school and the increasingly technologic workforce. Children from low-income families are at risk for home environments that fail to promote emergent literacy and for reading failure. A home environment that encourages learning and parents who are involved in their children's education are important factors in school achievement. Objective. To evaluate the effects of a literacy promoting intervention delivered by pediatric providers as part of well-child care on parent attitudes and behaviors and on child language. Design/Methods. A multicultural group of 205 low-income families with 5- to 11-month-olds were prospectively enrolled, interviewed, and randomized to intervention (n = 106) or control (n = 99) groups. Families in the intervention group received developmentally appropriate children's books and educational materials and advice about sharing books with children, while those in the control group received no books or materials relevant to literacy. After an average of 3.4 well-child visits in both groups, 153 (75%) were reinterviewed and the children's receptive and expressive vocabulary was tested using a modified version of the MacArthur Communication and Development Inventory (Short Form). Parents were asked if their child understood (receptive vocabulary) or said (expressive vocabulary) each of 100 words, half of which were in the books given. Families were found to have a Child-Centered Literacy Orientation if they mentioned reading aloud as one of their child's favorite activities or as one of their own favorite joint activities or if they usually read together at bedtime. At follow-up toddlers were 18.4 months old on average. Results. Intervention and control groups had similar literacy related characteristics at baseline. There was a 40% increase in Child-Centered Literacy Orientation among intervention families compared with 16% among controls. Intervention families read more with their toddlers (4.3 vs 3.8 days/week). Both receptive and expressive vocabulary scores were higher in older intervention toddlers (18–25 months old; n = 88), but not in younger intervention toddlers (13–17 months old;n = 62). This significant effect of the intervention on vocabulary scores in older toddlers was found for both the 50 words in the books and those not in the books. After parent education, foreign birth and language proficiency, and child age were statistically controlled, the intervention remained significantly associated with higher language outcomes in older toddlers. However, when reading aloud was added to the multivariate analysis, the influence of the intervention was no longer evident, suggesting the intervention's effect on child language was mediated through increased shared reading with these toddlers. Conclusion. This simple and inexpensive intervention, delivered as part of well-child care, changed parent attitudes toward the importance of reading with their infants and toddlers. These intervention parents and their children read more together and this was associated with enhanced language development in older toddlers in this diverse group of low-income families.

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Low-Income Parents' Views on the Redesign of Well-Child Care

PEDIATRICS ◽

10.1542/peds.2008-2608 ◽

2009 ◽

Vol 124 (1) ◽

pp. 194-204 ◽

Cited By ~ 34

Author(s):

T. R. Coker ◽

P. J. Chung ◽

B. O. Cowgill ◽

L. Chen ◽

M. A. Rodriguez

Keyword(s):

Child Care ◽

Low Income ◽

Well Child Care

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Factors Related to Immunization Status Among Inner-City Latino and African-American Preschoolers

PEDIATRICS ◽

10.1542/peds.96.2.295 ◽

1995 ◽

Vol 96 (2) ◽

pp. 295-301 ◽

Cited By ~ 10

Author(s):

David Wood ◽

Cathy Donald-Sherbourne ◽

Neal Halfon ◽

M. Belinda Tucker ◽

Vilma Ortiz ◽

...

Keyword(s):

African American ◽

Los Angeles ◽

Inner City ◽

Low Income ◽

African American Children ◽

Latino Children ◽

Health Maintenance ◽

Well Child Care ◽

American Children ◽

Public Clinics

Objective. To identify factors associated with undervaccination at 3 months and 24 months among low-income, inner-city Latino and African-American preschool children. Design. Interviews with a representative sample of inner-city families using a cross-sectional, multi-stage, cluster-sample design combined with a replicated quota sampling approach. Setting. South Central and East Los Angeles areas in inner-city Los Angeles. Population. Eight hundred seventeen Latino and 387 African-American families with children between 12 and 36 months of age. Main Outcome Variables. Being fully immunized or up-to-date (UTD) at 3 months (1 diphtheria-tetanus-pertussis vaccine and 1 oral polio vaccine) and 24 months of age (4 diphtheria-tetanus-pertussis vaccines, 3 oral polio vaccines, and 1 measles-mumps-rubella vaccine). Methods. Logistic regressions of UTD immunization status at 3 and 24 months by population and health care system factors. Results. Seventy percent of Latino children and 53% of African-American children were UTD at 3 months of age. At 24 months of age, 42% of Latino children and 26% of African-American children were UTD on their immunizations. Receipt of the first immunizations by 3 months was associated with smaller family size, and evidence of connection to prenatal care. Latino children were less likely to be UTD at 24 months if they obtained well child care from private providers versus public clinics (odds ratio [OR] = 0.45, 95% confidence interval [CI] = 0.26, 0.79). There was also a trend for Latino children to be less well immunized if they were in health maintenance organizations versus public clinics (0.31, .0.05 < P < .1). African-American children were more likely to be UTD at 24 months if they were UTD at 3 months (OR = 5.56, 95% CI = 1.43, 21.6), had more health visits (OR = 1.13, 95% CI = 1.01, 1.27), and were less likely to be UTD at 24 months if they were on Medicaid versus private insurance (OR = 0.26, 95% CI = 0.08, 0.90). Implications. Both African-American and Latino children in inner-city Los Angeles have low immunization rates at 3 and 24 months. Prenatal care and family size are strongly associated with being UTD by 3 months; however, family and child characteristics are relatively unimportant predictors of being UTD at 24 months of age. Important risk factors for underimmunization at 2 years of age in the inner-city, low-income communities studied include type of health insurance and source of well child care, with the public sector having higher rates than private doctors' offices or health maintenance organization/managed care plans.

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A Parent Coach-Led Model of Well-Child Care for Young Children in Low-Income Communities: A Cluster Randomized Trial Protocol (Preprint)

10.2196/preprints.27054 ◽

2021 ◽

Author(s):

Rachel Hurst ◽

Kendra Liljenquist ◽

Sarah J Lowry ◽

Peter Szilagyi ◽

Kevin A. Fiscella ◽

...

Keyword(s):

Child Care ◽

Low Income ◽

Pragmatic Trial ◽

Urgent Care ◽

Main Element ◽

Anticipatory Guidance ◽

Well Child Care ◽

Time Motion ◽

Cluster Randomized ◽

The Impact

BACKGROUND The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator ("Parent Coach") to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. OBJECTIVE To evaluate the impact of PARENT using a cluster randomized controlled trial (RCT). METHODS This study will test the effectiveness of PARENT at 10 clinical sites of two federally-qualified health centers (FQHCs) in Tacoma, WA and Los Angeles, CA. We are conducting a cluster RCT that includes 940 families with a child ≤ 12 months old at the time of the baseline survey. Parents will be followed up at 6 months and 12 months post-enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening/referral, and developmental and behavioral surveillance, screening, and guidance at each WCC visit, and is supported by parent-focused pre-visit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical exam and any concerns that require a clinician’s attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health–related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally-recommended WCC services, family-centeredness of care, and parent experiences of care) and healthcare utilization (WCC, urgent care, emergency department [ED], and hospitalizations), conduct a cost/cost-offset analysis, and conduct a separate Time Motion Study to assess clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent and parenting-focused outcomes. Our primary outcomes are receipt of anticipatory guidance and ED utilization. RESULTS Participant recruitment began in March 2019 and will continue through June 2021. After recruitment concludes, 6 and 12 month follow up surveys will be completed. Thus far, over 500 participants have been enrolled. CONCLUSIONS This large pragmatic trial of PARENT in partnership with FQHCs will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. CLINICALTRIAL ClinicalTrials.gov NCT03797898

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