Leveraging Primary Care to Enhance Home Visiting and Other Early Childhood Supports

Statement of Problem

Without good childhood health, development, safety and parenting engagement, children may not develop the foundation they need for lifelong health and well-being. Since the passage and investment of $1.5 billion in the Maternal, Infant and Early Childhood Home Visiting program (MIECHV) in 2010, home visiting programs have become key structural components of communities across the country in addressing these factors. Researchers have well documented the benefits of home visiting models, including improved maternal and child health indicators, school readiness, parenting satisfaction and connection to social services. 

The unprecedented increase of funding for key MIECHV models has created greater demand for public health-trained nursing staff to serve as home visitors. For vulnerable families with both medical and social complexities, these nurses provide preventive health services and health education, serve as care coordinators, and facilitate and maintain engagement with community health and social services. However, delivering effective training to nurses and sustaining competitive salaries is difficult, creating a need for new ways to encourage nurse applicants and retention of nurse staffing. As a result, pediatric primary care has become a promising venue to improve salary competitiveness and attract a wider range of nurse candidates given the duality of the role and the exposure to the health care system.

While the value of a nurse shared-staff model to families, communities and health care systems is untested, evidence suggests that such a model might potentiate health benefits, system efficiencies and cost savings. Longitudinal and controlled research studies have shown home visiting services have positive impacts on families’ health care utilization, adherence to well-child visit guidelines, immunizations, child safety and healthy physical and emotional development. Therefore, with this project we’re seeking to develop innovative models that take into consideration local contextual circumstances that impact these outcomes and that seek to engage the community and health care systems able to facilitate these effects in a comprehensive and coordinated approach.

Description

We are partnering with the Children's Hospital of Philadelphia (CHOP) Care Network and the National Nurse-led Consortium (NNCC) to design, pilot, and evaluate an integrated system of care between evidence-based maternal and child home visiting services and pediatric primary care. Known as the Community-Clinical Systems Integration (CSSI) Initiative, our objective is to identify areas of alignment between service delivery providers and develop a shared-staffing model that will create efficiencies and reduce burden, enhance coordination of care for patients and improve sustainability of quality services.

This staffing model will create a systems-level collaborative approach to serving families with significant social needs that features wrap-around home visiting supports delivered in synchrony with pediatric primary care. Our hope is that the collaboration of community-based home visiting professionals with the clinical care team in the primary care setting will result in improved coordination of care, family engagement in preventive care, child health outcomes, and patient and provider (home visitor and clinical care team) experience. This project also intends to support families in their decision-making process concerning quality child care and will establish a child care navigator position to support nursing and primary care staff in their engagement with families around quality child care services. 

The project planning team will identify specific areas and create opportunities for implementation of collaborative service delivery between models to include, but not limited to:

  • Physical Surveillance
    • Weight and growth monitoring, temperature, pulse, blood pressure, fetal heart rate, abdominal incision, etc.
    • Screening and assessments—GAD-7; ASQ (for SWYC); Edinburgh/PHQ9; intimate partner violence and substance use
    • Monitoring of children with special needs
  • Case Management and Care Coordination
    • Assessment of services mom/baby are connected to (for appropriateness, duplication, gaps, etc.)
    • Communication to clinical services about status of services and who the providers are
    • Assessment and joint planning of other services mom/baby may need
  • Anticipatory Guidance: regular education of mom (and others) that aligns with Bright Futures, a national health promotion and prevention initiative led by the American Academy of Pediatrics

We will pilot this project for three years and engage all partners and project advisory council members in program implementation, the monitoring of integration efforts, and the administration of continuous quality assurance and improvement efforts. PolicyLab will evaluate the project for demonstrated improvement of well-child visit outcomes, immunization compliance, emergency department reliance, parental awareness of child care and child care planning, parental awareness of early childhood injury and safety risk, and staff satisfaction and retention.

Next Steps

At the conclusion of the CSSI Initiative, we anticipate having developed a model of integrated care that health care systems and the vast array of home visiting models can replicate to support families. We will have also created a viable sustainable financing model for this community-clinical service delivery approach to preventive care. PolicyLab intends to document and disseminate our lessons learned, evaluation findings and recommendations for future implications of this work.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Opportunities for Achieving Enhanced Home Visiting through Place-Based Integration of Early Childhood Supports  [Online] Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].