OBJECTIVE. Our goal was to evaluate the feasibility and impact of an intervention on the management of family psychosocial topics at well-child care visits at a medical home for low-income children.PATIENTS AND METHODS. A randomized, controlled trial of a 10-item self-report psychosocial screening instrument was conducted at an urban hospital-based pediatric clinic. Pediatric residents and parents were randomly assigned to either the intervention or control group. During a 12-week period, parents of children aged 2 months to 10 years presenting for a well-child care visit were enrolled. The intervention components included provider training, administration of the family psychosocial screening tool to parents before the visit, and provider access to a resource book that contained community resources. Parent outcomes were obtained from postvisit and 1-month interviews, and from medical chart review. Provider outcomes were obtained from a self-administered questionnaire collected after the study.RESULTS. Two hundred parents and 45 residents were enrolled. Compared with the control group, parents in the intervention group discussed a significantly greater number of family psychosocial topics (2.9 vs 1.8) with their resident provider and had fewer unmet desires for discussion (0.46 vs 1.41). More parents in the intervention group received at least 1 referral (51.0% vs 11.6%), most often for employment (21.9%), graduate equivalent degree programs (15.3%), and smoking-cessation classes (14.6%). After controlling for child age, Medicaid status, race, educational status, and food stamps, intervention parents at 1 month had greater odds of having contacted a community resource. The majority of residents in the intervention group reported that the survey instrument did not slow the visit; 54% reported that it added 2 minutes to the visit.CONCLUSIONS. Brief family psychosocial screening is feasible in pediatric practice. Screening and provider training may lead to greater discussion of topics and contact of community family support resources by parents.
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机译：目的。我们的目标是评估在低收入儿童的医疗之家中进行的托儿保健访视时，对干预家庭心理社会主题进行管理的可行性和影响。患者和方法。在一家城市医院的儿科诊所进行了一项10项自我报告心理社会筛查仪器的随机对照试验。儿科居民和父母被随机分配到干预组或对照组。在为期12周的期间内，参加了2个月至10岁的儿童的父母参加了一次精心照看儿童的活动。干预措施包括提供者培训，在拜访前向父母管理家庭心理社会筛查工具，以及提供者访问包含社区资源的资源手册。父母的结局来自访问后和1个月的访谈，以及病历表审查。从研究后收集的自我管理问卷中获得提供者的结果。共有200名父母和45名居民参加。与对照组相比，干预组的父母与住院医生讨论了更多的家庭心理社会话题（2.9 vs 1.8），未满足的讨论欲望更少（0.46 vs 1.41）。干预组中更多的父母接受了至少1次推荐（51.0％比11.6％），大多数是就业（21.9％），研究生同等学位课程（15.3％）和戒烟班（14.6％）。在控制了孩子的年龄，医疗补助状况，种族，教育状况和食物券后，干预父母在1个月时接触社区资源的几率更大。干预组中的大多数居民报告说，调查仪器并没有减慢访问速度。 54％的人说它增加了不到2分钟的访问时间。结论。简短的家庭心理社会筛查在儿科实践中是可行的。筛选和提供者培训可能会导致对主题的更多讨论以及父母对社区家庭支持资源的接触。
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