Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. 547-558 (doi:10.1542/peds.2007-0398)

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ARTICLE

Improving the Management of Family Psychosocial Problems at Low-Income Children's Well-Child Care Visits: The WE CARE Project

Arvin Garg, MD, MPH^a, Arlene M. Butz, ScD, RN^a, Paul H. Dworkin, MD^b, Rooti A. Lewis, BA^a, Richard E. Thompson, PhD^c and Janet R. Serwint, MD^a

^a Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
^b Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
^c Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

OBJECTIVE. Our goal was to evaluate the feasibility and impact of an intervention on the management of family psychosocial topics at well-child care visits at a medical home for low-income children.

PATIENTS AND METHODS. A randomized, controlled trial of a 10-item self-report psychosocial screening instrument was conducted at an urban hospital-based pediatric clinic. Pediatric residents and parents were randomly assigned to either the intervention or control group. During a 12-week period, parents of children aged 2 months to 10 years presenting for a well-child care visit were enrolled. The intervention components included provider training, administration of the family psychosocial screening tool to parents before the visit, and provider access to a resource book that contained community resources. Parent outcomes were obtained from postvisit and 1-month interviews, and from medical chart review. Provider outcomes were obtained from a self-administered questionnaire collected after the study.

RESULTS. Two hundred parents and 45 residents were enrolled. Compared with the control group, parents in the intervention group discussed a significantly greater number of family psychosocial topics (2.9 vs 1.8) with their resident provider and had fewer unmet desires for discussion (0.46 vs 1.41). More parents in the intervention group received at least 1 referral (51.0% vs 11.6%), most often for employment (21.9%), graduate equivalent degree programs (15.3%), and smoking-cessation classes (14.6%). After controlling for child age, Medicaid status, race, educational status, and food stamps, intervention parents at 1 month had greater odds of having contacted a community resource. The majority of residents in the intervention group reported that the survey instrument did not slow the visit; 54% reported that it added <2 minutes to the visit.

CONCLUSIONS. Brief family psychosocial screening is feasible in pediatric practice. Screening and provider training may lead to greater discussion of topics and contact of community family support resources by parents.

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Key Words: low-income children • pediatrician • well-child care visit • family psychosocial problem

Abbreviations: AAP—American Academy of Pediatrics • WCC—well-child care • WE CARE—Well-child Care Visit, Evaluation, Community Resources, Advocacy, Referral, Education • FRB—Family Resource Book • GED—graduate equivalent degree

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Accepted Apr 13, 2007.

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