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