title: A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The goal of this study was to examine the effects of a new model for well-child care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families.
  
  
  METHODS
  PARENT includes 4 elements designed by using a stakeholder-engaged process: (1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each well-visit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey-PLUS was used to assess receipt of recommended WCC services at 12 months' postenrollment. Intervention effects were examined by using bivariate analyses.
  
  
  RESULTS
  A total of 251 parents with a child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than $20,000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fifty-two percent fewer intervention children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization.
  
  
  CONCLUSIONS
  A parent coach-led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.
authors.affiliation: UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California; RAND, Santa Monica, California; tcoker@mednet.ucla.edu.
authors.forename: Tumaini R
authors.initials: TR
authors.lastname: Coker
authors.affiliation: UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;
authors.forename: Sandra
authors.initials: S
authors.lastname: Chacon
authors.affiliation: RAND, Santa Monica, California;
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.affiliation: YBPC, Duarte, California;
authors.forename: Yovana
authors.initials: Y
authors.lastname: Bruno
authors.affiliation: Wee Care Associates, Compton, California;
authors.forename: Toni
authors.initials: T
authors.lastname: Chavis
authors.affiliation: UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;
authors.forename: Christopher
authors.initials: C
authors.lastname: Biely
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and.
authors.forename: Christina D
authors.initials: CD
authors.lastname: Bethell
authors.affiliation: UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;
authors.forename: Sandra
authors.initials: S
authors.lastname: Contreras
authors.affiliation: UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;
authors.forename: Naomi A
authors.initials: NA
authors.lastname: Mimila
authors.affiliation: UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Mercado
authors.affiliation: UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California; RAND, Santa Monica, California; UCLA Fielding School of Public Health, Los Angeles, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D002648:Child; D000067576:Child Health; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003191:Comprehensive Health Care / Q000458:organization & administration*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000523:psychology*; D011203:Poverty; D011314:Preventive Health Services / Q000191:economics / Q000379:methods*; D014481:United States