March 2016

Intergenerational Family Services: Serving Caregivers, Improving Child Health

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As a practicing pediatrician, David Rubin, MD, MSCE, saw firsthand how parents and guardians often were dealing with myriad issues that lessened his ability to help their children. Families would not fill prescriptions due to financial hardships, for example, or a parent with emotional disturbances would forget to pick up or administer her child’s medications. He realized that many other medical professionals shared these same kind of unfortunate anecdotes.

When Dr. Rubin became founding director of PolicyLab at The Children’s Hospital of Philadelphia in 2008, these experiences motivated him to engage in research and practice initiatives focused on intergenerational family services – health services provided to parents and caregivers in pediatric medical settings. Research conducted by PolicyLab experts and others has shown that innovative initiatives emphasizing family-centered care can have a powerful effect on the health and well-being of children. In other words, children do better when their caregivers do better.

PolicyLab recently launched an intergenerational family services research portfolio that will research, implement and test innovative ways to engage parents and guardians around their own physical and mental health needs and therefore improve their children’s health outcomes.

“We’re trying to move the needle on complex outcomes that may be driven by social determinants of health, such as what is going on within the home environment,” said Meredith Matone, DrPH, MHS, deputy director of PolicyLab who is overseeing the intergenerational family services research portfolio.

Novel Intervention for Postpartum Depression

Consider a new mom who has been diagnosed with postpartum depression, an incapacitating illness affecting anywhere from 10 to 20 percent of new mothers. She may feel too overwhelmed to seek healthcare services for herself or find a postpartum support group. If she happens to be a single parent in a low-income household, it also may be difficult for her to arrange childcare and transportation to attend traditional in-person meetings.

A novel intervention that is being evaluated by PolicyLab could be an opportunity in this case for mom to connect with peers, learn about postpartum depression, and reinforce good parenting skills — without needing to leave home. James Guevara, MD, a founding member of PolicyLab, and colleagues are developing a parent-coaching program for women with postpartum depressive symptoms, utilizing a social media format to enhance participation.

In a pilot randomized controlled trial, the study team is comparing the social media format to traditional in-person group formats and determining how the parent coaching affects new mothers’ depressive symptoms, sense of parenting confidence and parenting interactions with their infants. The Maternity Care Coalition of Philadelphia is collaborating with the study team to assess the feasibility and acceptability of the intervention in a community setting.

Evaluating Home Visitation Programs

Another example of PolicyLab’s ongoing intergenerational family services research is a statewide project for Pennsylvania that Dr. Matone and Dr. Rubin, who also is a professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics, are leading to evaluate federally-funded home visitation programs for families of young children.

So far, their results suggest that mothers who are participating in home-based services are more likely to receive the appropriate number of prenatal care visits, which potentially protects their infants from adverse birth outcomes. After they are born, those infants also are more likely to receive the recommended number of well-child visits.

“Doing this home-visiting evaluation for the past few years has reinforced for me the value of the delivery of care to parents and children together,” Dr. Matone said.

Transition to Accountable Care Organizations Ideal Timing

When PolicyLab announced in late 2015 its long-term strategy on intergenerational family services research efforts, it was ideal timing, Dr. Matone said. Healthcare reform has accelerated the transition to accountable care organizations (ACOs), of which CHOP is one. ACOs emphasize improving quality, value and patient outcomes using evidence-based prevention and care management strategies. The ambitious projects included in PolicyLab’s intergenerational family services research portfolio may provide helpful insights on how ACOs could possibly achieve those goals while reducing healthcare expenditures using holistic, family-centered programs and partnerships with community health organizations.

“At PolicyLab, our goal is to figure out how our investigators can take advantage of the tremendous health system that we’re in and our strengths as clinician-scientists to demonstrate innovation from here out,” Dr. Rubin said. “How do we start to implement and test these solutions?”

PolicyLab experts are embarking on a new project that will involve in-depth interviews with advocates, policymakers and other hospital administrators across the country to get a sense of the current landscape of intergenerational family services. This beginning phase will be the foundation for a plan to create a comprehensive set of informed recommendations for healthcare systems to incorporate effective intergenerational family services into pediatric practice.

Expanding Opportunities for Intergenerational Family Services Research

Meanwhile, Dr. Matone is always on the lookout for other policy opportunities on the national level that could be bolstered by intergenerational family services research. She pointed to the U.S. Preventive Services Task Force’s new recommendations for the delivery of maternal depression screening during pregnancy and the postpartum period. As a result, those screenings are now to be covered under the Affordable Care Act. This creates new research possibilities to explore how the policy change may translate into improved pediatric care.

Within PolicyLab, news of the intergenerational family services research portfolio has opened the doors for investigators to collaborate on ideas to promote family-based care, Dr. Matone said. It also has encouraged a discussion across CHOP and the Research Institute about the parent engagement side of various departmental initiatives, such as violence screening within the emergency department.

“Having this portfolio has allowed us to start to have more intentional conversations about activities that may be considered intergenerational family services, the success of those services, what assistance may be needed and their vision for moving forward,” Dr. Matone said. “We can help the institution be a leader in this area.”

Dr. Rubin expects these efforts will create a breadth of services that the medical community can access to support not just children but their parents. Fast-forward to a future well-child visit where he meets a new mother who seems to be struggling to care for her newborn.

“I’ll know how to help that mom by identifying her depression, following up with the appropriate resources, and every time she comes into my office, checking in on her progress,” Dr. Rubin said. “And that family will do better as that child grows up because I was working with her on that issue. That’s what it’s all about.”

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