- Email: [email protected]
Collaboration of Home Visiting and Primary Care Clinicians
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Collaboration of Home Visiting and Primary Care Clinicians As the director of a home based early childhood program that is executed within a public health agency, it is easy to recognize how valuable a collaborative approach with primary care clinicians could enhance outcomes for children and their families. When the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) monies provided by the ACA were passed down from the state in 2011, home based early childhood home visiting existed in the community but not at an evidenced level. With the advent of the regulations to use the money for evidenced based programming, there were arguably some growing pains in communities across the country, including excitement for the opportunity to serve more families but with uncertainty about what evidence based programs were out there and which one fit the needs of their community. Although a few states/communities were already leading the nation in home visiting with evidence based programming in place, there were many who were not. This likely contributed to the fact that communities like my own did not have more MOUs in place with stakeholders and, in particular, primary care clinicians as there was not enough attention dedicated to the planning phase. It is recognized that completing the process prior to the launching of programming is superior as it takes many community systems to substantially move families in positive directions. Prevention being paramount to public health, home visiting fits well, but the bar is high for prevention programs as they require that we show something did not happen and issues that many identified families face are complex. Most public health programs struggle with engagement, as well as attrition, and home visiting is no exception. Program sites spend much time and effort researching to identify systems that service providers can use to engage and retain the families within a community in which there is the most need.1 Families that may benefit the most, often prove to be the hardest to engage and retain. Most physicians are aware of their responsibility to refer children that they suspect have a developmental delay for a screening or diagnostic work up in recognition that the earlier a delay is identified, the better the outcome. Clinicians, however, may not be aware that home visiting is one way to reduce inequity and disparities while attempting to create a child health safety net. It is plausible that with such intervention, social determinants of health can be diminished and a healthier ACE score is predicted. Natural partnerships between a home visitor and physician are a sound goal, but the challenge will be helping physicians see the value of this service and the mechanics of how those partnerships can work. Collaboration can enhance outcomes of a child's health and well-being as the value of the relationship between the family and home visitor can help move a family to better choices. If reciprocated by a health care clinician, the value can be amplified and the number of families that can benefit from services in a particular community increased. This applies to clinicians providing care prenatally and for the first years of a child's life. The early connection with families assists the implementing agency in building that relationship with the prenatal mom when providing information regarding healthy lifestyle choices during pregnancy can make the most impact. Additionally, prenatal parents, especially first time parents, are generally an interested, captive audience and many of the topics that are important pieces of education in a medical prenatal office can be reinforced within the context of the home visit. A good example of that collaborative approach, as highlighted in this article, is that the AAP has recently endorsed the value of exclusive breastfeeding until six months of age and the identification of it being a public health issue that is best for baby, mom, and the nation's general well-being. Effective home visitors have the
Curr Probl Pediatr Adolesc Health Care 2016;46:130-131 1538-5442/$ - see front matter & 2016 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.cppeds.2016.02.006
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Curr Probl Pediatr Adolesc Health Care, April 2016
training to help mothers recognize the value and endorse its practice alongside the pediatrician. They are also knowledgeable about the resources that are available in a community to link mothers to qualified lactation support. Another example is the use of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool in home visiting. If a patient granted permission for the sharing of this information it could go a long way to help alter the existence of current negative influences in the home environment. To increase both a healthy birth outcome and a smoke free household, most home visiting programs also use resources to help prenatal and postnatal mothers quit smoking. Another collaborative opportunity is in the reduction of infant mortality by working with clinicians to educate and reinforce safe sleep practices. Additionally, screening for postpartum depression is of utmost importance to help mitigate potential consequences to the infant with a depressed mother. Best practice at this site is screening prenatally, within 30 days of the birth, and if the result is a positive screen, the mother is referred for counseling/medication. This is an area where collaboration with primary care physicians can be of substantial assistance and is especially true if timely accesses to mental health resources within a community are somewhat scarce. Home visiting sites are also particularly beneficial in educating about the importance of the primary care home, routine care, medical coverage, immunizations, and the early identification of delays. One last consideration is the cost estimate ranges that were offered. They appear to be higher than this program site which speaks to one of the challenges in supporting strong evidence based programming. Future program sustainability will likely hinge on the successful identification of enhanced revenue sources. With permission of the family, some risks factors identified by the primary care clinician could prompt an automatic referral and could be a consideration by a family's medical insurer as a sound investment. If insurers shared in some programmatic costs for families that face many obstacles to positive outcomes, the funding from the insurance companies could serve as the balance many states and communities need for service sustainability. In conclusion, clinicians may not have the required knowledge of the practice of home based early childhood home visiting to appreciate the value it can bring to the young families they treat. It seems to be the responsibility of early childhood advocates in each community to spread the word of the virtues of such services. It may be a challenge for a clinician in a busy practice to have the ability to share with a family how home visiting can be of help, so it is important that local sites do that work to ensure that all clinicians are offered information that can be shared with ease. This should also include that procedures, perhaps with MOUs, be developed so that a smooth referral system can be maintained. Lori Lambert, MA, LSW Clark County Combined Health District, Springfield, OH E-mail address: [email protected]
Reference 1. Daro D, McCurdy K, Falconnier L, Stojanovic D. Sustaining new parents in home visitation services: key participant program factors. Child Abuse Negl 2003;27(10):1101–25.
Curr Probl PediatrAdolesc Health Care, April 2016
131
Collaboration of Home Visiting and Primary Care Clinicians As the director of a home based early childhood program that is executed within a public health agency, it is easy to recognize how valuable a collaborative approach with primary care clinicians could enhance outcomes for children and their families. When the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) monies provided by the ACA were passed down from the state in 2011, home based early childhood home visiting existed in the community but not at an evidenced level. With the advent of the regulations to use the money for evidenced based programming, there were arguably some growing pains in communities across the country, including excitement for the opportunity to serve more families but with uncertainty about what evidence based programs were out there and which one fit the needs of their community. Although a few states/communities were already leading the nation in home visiting with evidence based programming in place, there were many who were not. This likely contributed to the fact that communities like my own did not have more MOUs in place with stakeholders and, in particular, primary care clinicians as there was not enough attention dedicated to the planning phase. It is recognized that completing the process prior to the launching of programming is superior as it takes many community systems to substantially move families in positive directions. Prevention being paramount to public health, home visiting fits well, but the bar is high for prevention programs as they require that we show something did not happen and issues that many identified families face are complex. Most public health programs struggle with engagement, as well as attrition, and home visiting is no exception. Program sites spend much time and effort researching to identify systems that service providers can use to engage and retain the families within a community in which there is the most need.1 Families that may benefit the most, often prove to be the hardest to engage and retain. Most physicians are aware of their responsibility to refer children that they suspect have a developmental delay for a screening or diagnostic work up in recognition that the earlier a delay is identified, the better the outcome. Clinicians, however, may not be aware that home visiting is one way to reduce inequity and disparities while attempting to create a child health safety net. It is plausible that with such intervention, social determinants of health can be diminished and a healthier ACE score is predicted. Natural partnerships between a home visitor and physician are a sound goal, but the challenge will be helping physicians see the value of this service and the mechanics of how those partnerships can work. Collaboration can enhance outcomes of a child's health and well-being as the value of the relationship between the family and home visitor can help move a family to better choices. If reciprocated by a health care clinician, the value can be amplified and the number of families that can benefit from services in a particular community increased. This applies to clinicians providing care prenatally and for the first years of a child's life. The early connection with families assists the implementing agency in building that relationship with the prenatal mom when providing information regarding healthy lifestyle choices during pregnancy can make the most impact. Additionally, prenatal parents, especially first time parents, are generally an interested, captive audience and many of the topics that are important pieces of education in a medical prenatal office can be reinforced within the context of the home visit. A good example of that collaborative approach, as highlighted in this article, is that the AAP has recently endorsed the value of exclusive breastfeeding until six months of age and the identification of it being a public health issue that is best for baby, mom, and the nation's general well-being. Effective home visitors have the
Curr Probl Pediatr Adolesc Health Care 2016;46:130-131 1538-5442/$ - see front matter & 2016 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.cppeds.2016.02.006
130
Curr Probl Pediatr Adolesc Health Care, April 2016
training to help mothers recognize the value and endorse its practice alongside the pediatrician. They are also knowledgeable about the resources that are available in a community to link mothers to qualified lactation support. Another example is the use of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool in home visiting. If a patient granted permission for the sharing of this information it could go a long way to help alter the existence of current negative influences in the home environment. To increase both a healthy birth outcome and a smoke free household, most home visiting programs also use resources to help prenatal and postnatal mothers quit smoking. Another collaborative opportunity is in the reduction of infant mortality by working with clinicians to educate and reinforce safe sleep practices. Additionally, screening for postpartum depression is of utmost importance to help mitigate potential consequences to the infant with a depressed mother. Best practice at this site is screening prenatally, within 30 days of the birth, and if the result is a positive screen, the mother is referred for counseling/medication. This is an area where collaboration with primary care physicians can be of substantial assistance and is especially true if timely accesses to mental health resources within a community are somewhat scarce. Home visiting sites are also particularly beneficial in educating about the importance of the primary care home, routine care, medical coverage, immunizations, and the early identification of delays. One last consideration is the cost estimate ranges that were offered. They appear to be higher than this program site which speaks to one of the challenges in supporting strong evidence based programming. Future program sustainability will likely hinge on the successful identification of enhanced revenue sources. With permission of the family, some risks factors identified by the primary care clinician could prompt an automatic referral and could be a consideration by a family's medical insurer as a sound investment. If insurers shared in some programmatic costs for families that face many obstacles to positive outcomes, the funding from the insurance companies could serve as the balance many states and communities need for service sustainability. In conclusion, clinicians may not have the required knowledge of the practice of home based early childhood home visiting to appreciate the value it can bring to the young families they treat. It seems to be the responsibility of early childhood advocates in each community to spread the word of the virtues of such services. It may be a challenge for a clinician in a busy practice to have the ability to share with a family how home visiting can be of help, so it is important that local sites do that work to ensure that all clinicians are offered information that can be shared with ease. This should also include that procedures, perhaps with MOUs, be developed so that a smooth referral system can be maintained. Lori Lambert, MA, LSW Clark County Combined Health District, Springfield, OH E-mail address: [email protected]
Reference 1. Daro D, McCurdy K, Falconnier L, Stojanovic D. Sustaining new parents in home visitation services: key participant program factors. Child Abuse Negl 2003;27(10):1101–25.
Curr Probl PediatrAdolesc Health Care, April 2016
131