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

Project Summary 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 pre visit 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 parentandapos 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 Child maltreatment CM involves about million US children placing them at risk for many short and long term negative consequences including medical developmental learning social and mental health problems and associated costs Family Stressors FS such as parental intimate partner violence substance abuse depression extreme stress and food insecurity and harsh punishment of their children are significant problems for families and also major risk factors for CM This project is to refine and test an innovative Family Stressors Module of a web system now used by primary healthcare providers PCP of children in states to include pre visit parent report screening tools for FS ACE Resilience and Best Hardest parts of parenting to generate decision support teleprompters for PCPs to provide more psychosocially oriented care plus use motivational interviewing to increase accessing help by parents for their FS thereby reducing CM