Mentors, video may improve primary care among children in poverty

BALTIMORE — Parent mentors and coaches, video and technology, and better implementation in schools could all be effective ways to improve health outcomes among children living in poverty that primary care providers can foster, according to data presented at the Pediatric Academic Societies Meeting.

Speaking during a symposium Sunday, the presenters noted the dire figures currently marking the realities of children in poverty — 4.8 million U.S. children, or about 6%, are uninsured. Of those uninsured children, 62% to 72 %, or about 3.5 million, are eligible for, but not enrolled in, Medicaid or CHIP. There are also racial disparities, with 5% of white children uninsured, compared with 8% among African American children and 12% among Latino children.

“But not enough is known about the most effective ways to insure uninsured children, and no study has examined the effectiveness of parent mentors,” Glenn Flores, MD, of the Medical Research Institute, in Minnesota, said during his presentation.

Flores and his colleagues conducted randomized controlled trial on the effects of parent mentors on insuring uninsured minority children. The resulting Kids’ HELP trial saw participants in the intervention group meet with parent mentors who had been trained in addressing different types of insurance programs, their associated documentation and application process, being a liaison and advocate for families to Medicaid and CHIP, renewing coverage, obtaining pediatric care and helping families with food, clothing and other social determinants of health.

According to Flores, parent mentors were significantly more effective than traditional Medicaid and CHIP outreach enrollment efforts in insuring low-income minority children, as well as, renewing coverage, improving access to medical and dental care, reducing medical needs and out of pocket costs, and achieving parental satisfaction. They’re also cost effective, saving $6,045 per child insured, Flores said.

“The findings suggest that implementing parent mentors nationally could save over $10.5 billion, and if the intervention were shown to be effective for all race and ethnic groups, for all uninsured children, it could save 20.1 billion,” he said.

Another approach, presented by Alan, L. Mendelsohn, MD, from the New York University School of Medicine, was the Video Interaction Project (VIP), in which families meet with a coach, who provides toys, books and pamphlets on parenting best practices. In addition, parents and children are recorded interacting, with the coach offering a guided review, in which the counselor offers input.

“We have shown robust impacts on parent-child relationships, including increased reading aloud, talking and teaching, as well as increased quality of play, reduced screen time and reduced physical punishment,” Mendelsohn said. “At the same time, we have found that as parents engage in these more positive activities, there are reduced parental depression symptoms, reduced parental stress. Also, with the children, there is improved cognitive and language development, and, most robustly, reduced behavioral problems, including hyperactivity and depression.”

Tumaini Rucker Coker, MD, MPH, of the University of California, Los Angeles, presented research on another parent mentor program, called PARENT (Parent-Focused Redesign for Encounters, Newborns to Toddlers), aimed at well-child care. In this program, studied during a 12-month pilot including two practices, health educators met with families during well-child visits to a primary care physician. This 20-minute meeting would occur after the medical assistant weighs and measures the baby, and before the physician sees the family, when the parent would typically be sitting and waiting.

The mentor would then discuss any concerns the parent has regarding the child, provide information about community referrals that may be required, and discuss the children developmental and behavioral progress. The mentor would document the meeting, and make the information immediately available for the physician.

“The parents in the intervention group performed better regarding receipt of child care services, they had better experiences of care and fewer ED visits than the control,” Coker said.

Presenting data from a study on integrating primary care and schools in low-income communities, Tina L. Cheng, MD, of Johns Hopkins University, in Baltimore, noted the widening life-expectancy gap between the educated and less educated.

Cheng and colleagues developed the Rales Center, to “break down those silos” and “weave health into education.” They tested their model in the KIPP Baltimore charter schools, with a total of more than 1,500 students, involving a full-service school clinic, wellness and screening programs, a school health curriculum, and initiatives focused on parent and teacher health.

According to Cheng, the school nurses are referring fewer students to EDs, and immunization has increased. Chronic disease management and medication adherence have also increased, all at a cost savings, she added.

“There’s a role for pediatric health professions, child health professionals, at every level of trying to help this connection between poverty and health,” Jonathan Arie Finkelstein, MD, of Harvard Medical School, said in closing the symposium. “We should be right at the front of, but it will take a lot of time in our society, and what we’ve tried to focus on are things we are doing and testing now, that could be implemented and adapted across communities. And to understand there are things we all could be doing in our clinics and our communities while we’re waiting for the whole world to change.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.

Reference:

Coker TR, et al. Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT): A parent-coach led model for well-child care. Presented at: Pediatric Academic Societies meeting; April 30 to May 3, 2016; Baltimore.

Flores G, et al. Kids’ HELP: A parent mentor intervention. Presented at: Pediatric Academic Societies meeting; April 30 to May 3, 2016; Baltimore.

Cheng TL, et al. Integrating primary care and schools for underserved children. Presented at: Pediatric Academic Societies meeting; April 30 to May 3, 2016; Baltimore.

Mendelsohn AL, et al. Video Interaction Project (VIP): Improving child developmental outcomes for children ages 0-5 living in poverty. Presented at: Pediatric Academic Societies meeting; April 30 to May 3, 2016; Baltimore.