Can Primary Care “Coaches” Improve Child Health?

Pediatricians have an enormous number of issues to cover in a typical 15-minute well child visit: health history and physical exam; developmental screening; screening for social needs like housing and food insecurity; and anticipatory guidance, or advice about safety and what a parent or caregiver can expect in the coming months and years of a child’s life.

Realistically, pediatricians can’t cover everything that they want to or that families need. In addition, parents of young children are stressed out and may be embarrassed or otherwise reluctant to admit the challenges they face. They may not trust that a highly educated doctor can appreciate their lives, and this may be particularly true in traditionally under-resourced communities.

To address these concerns, the Nationwide Children’s Hospital Primary Care Network has begun implementing the largest-scale trial of its kind in the United States, using community navigators or “coaches” to help young children and their families receive all of the preventive care they need. The coaches will come from the communities they serve, be integrated into the primary care office, and help identify a family’s unique challenges and help connect them to resources that can help.

The project is being funded with a $5 million research award from the Patient-Centered Outcomes Research Institute (PCORI).

Called PARENT, or Parent-focused Redesign for Encounters, Newborns to Toddlers, the model will put a special focus on improving health for Black parents and their children to address disparities in health outcomes. The PARENT model was first developed at Seattle Children’s Hospital, and Seattle Children’s is partnering with Nationwide Children’s in this work.

“We see it every day, that primary care offices are doing their best, and parents are doing their best, but gaps still exist that when bridged can help optimize care for children,” said Akua Amponsah, MD, primary care physician in Nationwide Children’s Primary Care Center in the Linden neighborhood, associate division chief for population health, and a leader in this new effort.

“What we want to come out of this is a framework for parents to feel more empowered by a coach who is culturally sensitive, community informed and who is a trusted advocate for families,” said Dr. Amponsah.

Tumaini Rucker Coker, MD, MBA, division chief of General Pediatrics at Seattle Children’s and professor of Pediatrics at the University of Washington School of Medicine, originally helped develop the model, and she helped kick off its implementation at Nationwide Children’s in February. She spoke to Nationwide Children’s doctors about the importance of the coach, and that can lead to better team-based care.

“In hiring the coaches, you focus more on lived experience than school experience,” she said. “Then you train them in things like trauma-informed care and motivational interviewing, and it helps if the entire team is involved in that training. The coaches also spend a lot of time making connections with community-based organizations.”

Once these kinds of coaches were introduced in some smaller scale trial in Washington State, parents began to report that they had better experiences in their child’s well-care visits, and parents actually became more likely to be up-to-date on their child’s checkups, Dr. Coker said.

Nationwide Children’s project is not just about implementation, but it’s also about research, said Alex Kemper, MD, division chief of Primary Care Pediatrics at Nationwide Children’s. The effectiveness of the health coach program will be studied as the program is rolled out, and lessons learned during the early phases will inform what happens in later phases. In the end, Nationwide Children’s and Seattle Children’s hope to have a fully developed model that can be tailored to other geographical areas and populations that face health inequities.

“The current way well-child care works in the United States never underwent this level of planning before,” he said. “That’s really important in understanding what we’re trying to do. We want to show that this level of planning, with focus on the communities where families live, can make a difference.”