Partnering with Community Health Workers to Support Families of Hospitalized Children with Limited English Proficiency

Background: Children and families with limited English proficiency (LEP) face many barriers to adequate health care. In the hospital setting, multiple studies have shown decreased comprehension of care and discharge readiness, and higher risk of serious medical events. Community health workers (CHWs), who are typically integrated into the outpatient setting, apply a culturally sensitive, peer-based approach to support patients, and are effective in reducing health disparities in underserved populations by improving knowledge, health care utilization, and health outcomes. In this study, we piloted a CHW-led program for families of hospitalized children with LEP to assess the caregiver’s understanding and knowledge about the child’s inpatient care plan and medications.

Methods: Hospitalized Latinx children and their caregivers with LEP were identified five days a week by resident teams through the electronic medical record (EMR) and during morning rounds. Using a HIPAA-secure video platform or phone calls, Spanish-speaking CHWs completed assessments of the caregiver’s comprehension of the patient’s diagnosis, medications, and outpatient follow up. Answers were uploaded into the EMR for the medical team to review. Responses were evaluated for accuracy by comparing to the attending physician’s note from the day of the assessment, and rated as completely, somewhat, or not concordant. In addition, children with medical complexity were referred to the CHW care coordination program for longitudinal support.

Results: In a six-month pilot period from January-June 2021, 118 caregivers of hospitalized children were identified as Spanish-speaking with LEP, of which 93 participated in the program. Patient age ranged from 4 days to 25 years. On average, families were assessed on the first day of hospitalization. CHWs identified 19 caregivers (20%) who felt unsure about their knowledge of their child’s medical care. Fifty-three caregivers’ answers (57%) were completely concordant with the medical team regarding the patient’s diagnosis, and 49 (52%) were completely concordant about medications. CHWs identified 12 caregivers (13%) without health insurance or primary care doctors. Twenty-one families (23%) were referred to the CHW care coordination program.

Conclusion: Integration of CHWs in the inpatient setting may be an effective approach to recognize caregivers with LEP in need of more support or improved communication from the medical team. CHWs can empower families identified as LEP to better understand their children’s medical care and arrange appropriate follow up, which is crucial for safe discharge. In addition, CHW integration can lead to longer-term CHW support for children with medical complexity.