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Intervention improves immunization, preventive care among low-income families

The Developmental Understanding and Legal Collaboration for Everyone intervention was associated with accelerated access to concrete supports, improved rates for on-time vaccinations and preventive care and decreased ED use among low-income families of healthy newborn infants, according to study results.

As policy changes in health care have allowed for low-income families to gain access to health insurance, the health care system adapted to the challenge of meeting the specific needs of these families while achieving quality benchmarks for preventive care, according to background information provided in the study.

For the randomized trial, researchers led by Robert Sege, MD, PhD, of the department of pediatrics at the Boston Medical Center, sought to assess the implementation of Project Developmental Understanding and Legal Collaboration for Everyone (DULCE) — aimed at improving care for healthy newborns and their families at a single, large, urban, safety-net hospital.

The intervention was based on the Strengthening Families approach and included components of the Healthy Steps and Medical-Legal Partnership models. A family specialist provided support until the 6-month routine health care visit. The use of preventive and emergency care were determined via medical record review; surveys conducted at baseline, 6 months and 1 year assessed hardship and attainment of concrete support.

According to study results, 73% of the 330 families included in the study reported economic hardships. Median parent age was 29 years; half were first-time parents. Median household income was between $10,000 and $30,000; 59% of respondents reported unemployment. Overall, 61% of participants reported food insecurity and 45% reported housing insecurity, of which 28% reported not able to pay rent or mortgage and 6% reported eviction.

The DULCE intervention led to accelerated access to concrete resources (P=.029). Families assigned the intervention reported an average of 14 contacts with the family specialist and 5 hours of total contact time.

Compared with the control arm, infants assigned the intervention arm were more likely to complete the 6-month vaccination schedule by age 7 months (77% vs. 63%; P<.005) and by age 8 months (88% vs. 77%; P<.01). In addition, infants included in the intervention arm were more likely to have five or more routine preventive care visits by age 1 year (78% vs. 67%; P<.01) and were less likely to visit the ED by age 6 months (37% vs. 49.7%; P<.03).

“Project DULCE offers a promising method of delivering services that appears to improve the quality of preventive service delivery without disrupting core clinical operations,” the researchers wrote. “This may prove to be a useful innovation in developing comprehensive, family-centered, community-based systems to support

Disclosure: The researchers report no relevant financial disclosures.