Improving the management of family psychosocial problems at low-income children's well-child care visits: The WE CARE project
Improving the management of family psychosocial problems at low-income children's well-child care visits: The WE CARE project
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DOI：
10.1542/peds.2007-0398
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发表时间：
2007-09-01
期刊：
影响因子：
8
通讯作者：
Serwint, Janet R.
中科院分区：
文献类型：
--
作者：
Garg, Arvin;Butz, Arlene M.;Serwint, Janet R.
目标。我们的目标是评估一项干预措施在低收入家庭儿童的医疗之家的健康儿童护理访问中对家庭心理社会问题管理的可行性和影响。患者和方法。在一家城市医院的儿科诊所进行了一项10项自我报告心理社会筛查工具的随机对照试验。儿科住院医师和家长被随机分配到干预组或对照组。在为期12周的时间里，有2个月至10岁儿童的父母参加了儿童保育访问。干预措施包括对提供者进行培训，在访问前向父母提供家庭社会心理筛查工具，以及提供者获得包含社区资源的参考书。父母的结果通过访问后和1个月的访谈以及病历回顾获得。提供者的结果是通过研究后收集的自我管理问卷获得的。200名家长和45名居民参加了这项研究。与对照组相比，干预组的父母与他们的住院医生讨论了更多的家庭心理社会话题（2.9比1.8），并且没有满足的讨论愿望更少（0.46比1.41）。干预组中更多的家长至少接受过一次转诊（51.0%对11.6%），最常见的是就业（21.9%），研究生同等学位课程（15.3%）和戒烟课程（14.6%）。在控制了孩子的年龄、医疗补助状况、种族、教育状况和食品券后，干预父母在1个月时接触社区资源的几率更大。干预组的大多数居民报告说，调查工具没有减缓访问；54%的患者报告就诊时间增加< 2分钟。简单的家庭心理筛查在儿科实践中是可行的。筛查和提供者培训可能会导致家长更多地讨论话题和接触社区家庭支持资源。
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.