The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention is a team-based approach to WCC relying 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. To address the gaps in current WCC, we partnered with federally qualified health centers (FQHCs) to develop a new model of WCC to meet the needs of children in low-income communities. This can lead to suboptimal quality of WCC services, resulting in missed opportunities to intervene and support the health and well-being of children in low-income communities. These problems in the structure of WCC are a key contributor to the wide variations in both, the processes of WCC and the receipt of preventive care services. Major structural problems with WCC include (1) reliance solely on busy clinicians (pediatricians, family physicians, or nurse practitioners) for most basic, routine WCC services, (2) limited to brief (often 15- to 20-minute) face-to-face clinician-directed WCC visits to address the wide array of education and guidance services in WCC (3) the need for high-level clinicians to focus clinical time on patients with complex medical needs, and (4) lack of a systematic, patient-driven method for visit customization to best meet families’ needs. In the United States, WCC is not optimally structured to meet the vast array of preventive care needs that families in low-income communities often have. Unfortunately, this unmet need is often the greatest for low-income families as they often have substantial needs. Despite the great potential of WCC to positively impact child health and well-being, multiple studies have demonstrated that many children do not receive all recommended preventive and developmental services during these visits, and that most parents do not have all of their psychosocial, developmental, and behavioral concerns addressed at these WCC visits. Well-child care (WCC) visits for child preventive care during the first 3 years of life are important opportunities to address social, developmental, behavioral, and health concerns of young children and their families. Our primary outcomes were receipt of anticipatory guidance and emergency department use. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination 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. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. Parents will be followed up at 6 and 12 months after enrollment. We conducted a cluster randomized controlled trial that included 916 families with children aged ≤12 months at the time of the baseline survey. This study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California.
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