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A clinical process support system for primary care to address family stress

用于解决家庭压力的初级保健临床流程支持系统

基本信息

批准号：
9537718
负责人：
Barbara Jo Howard
金额：
$ 73.5万
依托单位：
TOTAL CHILD HEALTH, INC.
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-11 至 2020-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9537718
关键词：
Accounting Address Adult Affect Age Appointment Behavior Caring Charge Child Child Abuse and Neglect Child Behavior Child Development Child Rearing Child abuse prevention Child health care Childhood Clinical Communication Computers Consent Counseling Data Data Analyses Data Set Development Documentation Early Diagnosis Early identification Education Effectiveness Elements Emotional Empathy Family Feedback Food Health Health Personnel Human Impairment Internet Intervention Intervention Trial Interview Learning Link Medical Mental Depression Mental Health Modification National Institute of Child Health and Human Development Outcome Outcome Study Parent-Child Relations Parents Periodicity Phase Populations at Risk Preventive Primary Health Care Problem behavior Process Provider Public Health Punishment Questionnaires Randomized Randomized Controlled Trials Reporting Research Resources Risk Risk Factors Safety Secure Social Workers Stress Substance abuse problem Suggestion Supervision Support System System Testing Text Time Training Vaccines Visit World Health abuse neglect base behavior change behavioral outcome care systems checkup examination cognitive development cost design evidence base experience family support follow-up group intervention improved information gathering innovation interest intimate partner violence motivational enhancement therapy premature programs prototype psychoeducation psychosocial resilience response satisfaction screening skills social social health determinants stressor tool web site

项目摘要

This proposal addresses the NICHD focus of specific interest for the prevention of child abuse and neglect in at risk populations. Child abuse and neglect often confers short- and long-term impairment of the physical, emotional, and cognitive development of children. The proposed project builds on promising data from previous randomized control trials, based on application of a screening tool in primary care pediatric practice that identifies the Family Stressors and use of harsh punishment, which are known to put children at risk for child abuse and neglect. Pediatric check-ups are ideal for early identification because of nearly universal and repeated access. However, these visits, also known as “child health supervision” have been charged with a heavy public health burden of early detection and preventive counseling for a wide variety of issues related to health risks, safety, and promoting child development during narrow time constraints. We have previously built a system to assist with this challenge by off-loading the burden of information gathering to an online previsit platform called CHADIS that has been used by over one million parents already. However, when the visit scope is broadened to addressing sensitive family stressors, the challenge for PCPs becomes one of clinical interviewing skills, that, in part, is best addressed with the evidence based approach known as motivational interviewing (MI). PCPs have not been trained for MI and it typically takes longer than the time allotted for the visit. The innovation proposed here is to collect data online before visits to not only identify problems, but also divide the interview process so that the computer collects data in a way that guides the PCP during the visit with details and suggested words (“teleprompters”) for the human elements of empathy and reflective listening that can be delivered briefly. In addition, the innovation also reduces documentation burden and creates follow-up psycho-education and tracking. This new Family Stress Module supports not only a single problem visit but also acts across visits in creating the psychosocial orientation for parents of children of all ages to confide in the PCP as well “anticipatory guidance” reinforced by “MemoryBook” and text messages. Electronic linking will be created with local referral resources, such as agencies or therapists, so when a referral is made two way communication is facilitated as well as tracking of appointment completion with the parent’s consent. There are no other clinical process support systems of similar scope and none connected to an electronic system of care bridging medical and social domains. The project involves first refining a prototype with parent and doctor feedback and then conducting a cluster randomized intervention trial. Hypothesized outcomes are lower rates of child abuse and neglect reports, less harsh punishment, as well as improved developmental and behavioral outcome in the intervention group. Parent satisfaction with the enhanced clinical process and collateral benefits, such as lower rates of missed visits and delayed vaccines will also be assessed.

这一建议解决了儿童发展中心在预防儿童虐待和忽视方面特别关注的重点问题