Community Health Workers Key to Improved Well-Child Visits

Seattle Children’s

Research conducted at Seattle Children’s Research Institute finds implementing a team-based approach to preventive care may improve health equity disparities in early childhood care.

Well-child care visits are important healthcare milestones in early childhood. Effective well-child care visits play a vital role in improving children’s health for the long term – providing preventive support to caregivers through physical examinations, immunizations, vision and hearing screenings, developmental and behavioral health assessments, and education.

For many families, primarily racial and ethnic minorities and those with reported low incomes, current well-child care visits may lack adequate preventive care services. In these situations, parents leave the visit with social, developmental and behavioral concerns that cannot be addressed within the usual 15-minute appointment.

Dr. Tumaini Coker, division head of general pediatrics and professor of pediatrics at the University of Washington School of Medicine, and other collaborators from Seattle Children’s Center for Child Health,

Behavior and Development have been working to eliminate these barriers. The study team piloted an interventional model for well-child care known as the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) which incorporates a community health worker as a member of the well-child care team.

A community health worker plays a vital role in this model. They serve as an advocate for the family and address the family’s social, psychosocial and developmental needs to provide parenting support in collaboration with the primary clinician. The five-year study was conducted across 10 different clinics in Los Angeles, California, and Pierce County, Washington, serving populations largely insured by Medicaid and comprising 914 parents with a child younger than 2 years of age. Of these parents, roughly half of them participated in the PARENT model and the others received usual care.

Recently published in JAMA, the study finds parents who took part in the intervention reported receiving more services during their visits compared to those receiving usual care. These parents received more guidance on a wide range of parenting issues, had helpful discussions with their well-child care team and attended more well-child care visits. These findings can lead to future improvements in the way that well-child care visits are delivered to families during early childhood.

While this is one of the first studies to examine the role community health workers can play in the design of well-child visits, in the long term, support for clinics will be needed to implement this model nationally. Adequate training, Medicaid reimbursement and equitable pay for community health workers will be the first step – with the goal of having a team to support caregivers in ensuring optimal health and well-being of young children and their families during the often challenging, yet wonderful, years of early childhood.

To learn more about this study, read the Publication Q&A: Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children: A Randomized Clinical Trial on seattlechildrens.org.

Seattle Children’s Research Institute contributing researchers:

· Tumaini R. Coker

· Kendra Liljenquist

· Sarah J. Lowry

· Taylor Salaguinto

· Laura J. Sotelo Guerra

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