Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children: A Randomized Clinical Trial

• Published in: JAMA : the journal of the American Medical Association 2023-05, Vol.329 (20), p.1757-1767
• Main Authors: Coker, Tumaini R, Liljenquist, Kendra, Lowry, Sarah J, Fiscella, Kevin, Weaver, Marcia R, Ortiz, Janette, LaFontaine, Rachel, Silva, Javier, Salaguinto, Taylor, Johnson, Gina, Friesema, Lisa, Porras-Javier, Lorena, Guerra, Laura J. Sotelo, Szilagyi, Peter G
• Format: Article
• Language: English
• Subjects: Age; Child Care; Child Health; Childhood; Children; Children & youth; Clinical trials; Community health care; Community Health Workers; Emergency medical care; Emergency medical services; Female; Government programs; Health care facilities; Hispanic or Latino; Humans; Income; Indigent care; Infant; Infant, Newborn; Intervention; Medicaid; Medical personnel; Minority & ethnic groups; Mothers; Neonates; Online First; Original Investigation; Parents; Parents & parenting; Patient Care Team; Preventive Medicine; United States
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2023.7197

IMPORTANCE: An intervention model (the Parent-focused Redesign for Encounters, Newborns to Toddlers; the PARENT intervention) for well-child care that integrates a community health worker into preventive care services may enhance early childhood well-child care. OBJECTIVE: To examine the effectiveness of the PARENT intervention vs usual care for parents with children younger than 2 years of age. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized clinical trial was conducted between March 2019 and July 2022. Of the 1283 parents with a child younger than 2 years of age presenting for a well-child visit at 1 of the 10 clinic sites (2 federally qualified health centers in California and Washington) approached for trial participation, 937 were enrolled. INTERVENTION: Five clinics implemented the PARENT intervention, which is a team-based approach to care that uses a community health worker in the role of a coach (ie, health educator) as part of the well-child care team to provide comprehensive preventive services, and 5 clinics provided usual care. MAIN OUTCOMES AND MEASURES: There were 2 primary outcomes: score for parent-reported receipt of recommended anticipatory guidance during well-child visits (score range, 0-100) and emergency department (ED) use (proportion with ≥2 ED visits). The secondary outcomes included psychosocial screening, developmental screening, health care use, and parent-reported experiences of care. RESULTS: Of the 937 parents who were enrolled, 914 remained eligible to participate (n = 438 in the intervention group and n = 476 in the usual care group; 95% were mothers, 73% reported Latino ethnicity, and 63% reported an annual income