121 - Implementation of a Dyadic Primary Care Model Across a Large Municipal Health Care System

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 121
Publication Number: 121.115

Ariel Charney, NYC Health and Hospitals, NYC, NY, United States; Natalie Cohen, NYC Health+Hospitals, Brooklyn, NY, United States;Sanjana Manjunath, New York University Grossman School of Medicine, New York, NY, United States; Mary McCord, NYC Health+Hospitals/Gotham Health, New York, NY, United States; Arthur H. Fierman, NYU Grossman School of Medicine, New York, NY, United States; Katherine Piwnica-Worms, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Sarah Sisco, NYC Health + Hospitals, New York, NY, United States; Mary C. Acri, New York University Grossman School of Medicine, New York, NY, United States

Presenting Author(s)

AC

Ariel Charney, MPH (she/her/hers)

Data Analytics Lead
NYC Health and Hospitals, Ambulatory Care and Population Health
NYC, New York, United States

First Author(s)

Natalie Cohen, Masters in Public Health (she/her/hers)

Director of Program Operations, 3-2-1 IMPACT!
NYC Health+Hospitals
Brooklyn, New York, United States

Background: Several pediatric primary care-based programs have demonstrated enhancements to early child development. It is not known whether concurrent integration of more than one such program into pediatric practice, combined with a focus on maternal mental health and well-being, will have additive positive effects.

Objective: To assess the feasibility of implementing the Integrated Model for Parents and Children Together (3-2-1 IMPACT) at three New York City Health+Hospitals (H+H) clinical sites. This model combines evidence-based early childhood programs (HealthySteps, Video Interaction Project and Reach Out and Read), maternal mental health services, resource navigation support, and electronic medical record (EMR) builds for standardized data and billing capture.

Design/Methods: Program component fidelity, accessibility, capacity and coordination was assessed via EMR data, stakeholder interviews, and clinic staff (i.e. providers, leadership, administrative staff) and caregiver surveys. Surveys were collected via convenience sampling, and measured perceived satisfaction, buy-in, caregiver feedback, and barriers and facilitators to implementation. Key stakeholder interviews informed creation of a journey map depicting families’ experiences navigating through the program.

Results: From 09/2020 to 09/2022, 65% of prenatal patients (n=5,190) and 52% of children ages 0-4 (n=7,191) were engaged in ≥ 1 IMPACT service. Most clinic staff across domains (Table 1; n=138) indicated favorable perceptions of the program (57-89%), with facilitators being communication (37%) and a strong sense of trust between primary care and behavioral health teams when collaborating on treatment plans (25%); areas for improvement included communication, referral workflows, and staffing models (Table 2; n=84). Caregivers (Table 3; n=369) indicated high levels of satisfaction, reporting that services were easily accessible (57%), matched their needs (69%), and were supportive (84%). Areas for improvement among caregivers included increasing clinic resources and reducing appointment wait times. Journey mapping interviews indicated that sites have successfully integrated IMPACT’s service goals with slight differences in pathways and staffing models.

Conclusion(s): IMPACT’s evaluation demonstrates early success of implementing a two-generation pediatric primary care model at fidelity and scale. Based on results from this pilot, IMPACT components are expanding systemwide across H+H, with child and dyadic health outcomes under investigation.