P0048 - Group Well Child Care as a Strategy to Support Parents

Background: We implemented a pilot group well child care (GWCC) program as an alternative to individual well child care (IWCC) in a large, urban, pediatric practice caring for children insured by Medicaid, with the overarching goals of increasing parent empowerment and social support

Our GWCC model was conceived as an extension of existing CenteringPregnancy group perinatal care programs, enrolling groups of approximately 6-8 parents and their newborns. GWCC follows Bright Futures guidelines for well-visit schedule from birth to age 2. A clinician facilitates the group, with a nurse co-facilitator who serves as program coordinator and delivers pediatric nursing care (measurements, immunizations, scheduling). Both trained by the CenteringCare Institute.

Methods: We reviewed charts for all GWCC enrollees through June 2019 plus a cohort of gender- and age-matched peers from the practice. To assess family experience of care, we completed structured telephone interviews with parents of infants under 6 months after a scheduled visit regarding their community needs and experience of care, programs, and services including 49 IWCC participants recruited from a clinic visit in October 2018 (64% response rate), and 8 GWCC participants (50% response rate) recruited following the 2- or 4-month GWCC visits that met between February and May 2019. Considerations and lessons learned were identified through debrief and feedback from GWCC facilitators and clinical leadership.

Findings: There were no differences in: rates of positive postpartum depression screens, parent perception of infant health, unmet health care needs, or measures of family resilience. GWCC infants were more likely to be complete and on-time for their well child care.

While nearly all reported at least one source of emotional support with parenting, GWCC parents (75%) more often endorsed relying on peer support than did IWCC parents (8%), and endorsed the value of the social support the group provided (75%) and learning from other mothers (50%). GWCC parents less often described themselves in excellent mental health. Program facilitators speculate that GWCC parents may self-select this care type because it allows interaction with peers and may be more comfortable sharing their opinions, which in the case of mental health may not yet meet the threshold for clinical concern. These findings point to the importance of promoting positive maternal mental health as part of GWCC.

Unmet community needs were common, with nearly all (98%) GWCC and 68% among IWCC reporting unmet needs (housing, food, financial). No GWCC mothers reported transportation barriers, vs 28% of those obtaining IWCC. Partnership with on-site social needs navigators improved facilitators’ ability to identify and address unmet community-based needs of GWCC parents.