JMIR Publications

ABSTRACT

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. Clinical Trial: ClinicalTrials.gov NCT03797898