Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Consultation (Parent/Family), Outreach (School Staff),

Intervention Description: The study examined the effectiveness of an ambulatory behavioral health urgent care pilot project, the Urgent Evaluation Service (UES), in reducing emergency department (ED) visits and improving collaborations with schools in the local community. The UES model involved same-day, ambulatory psychiatric evaluation and care coordination for school-aged children experiencing behavioral health crises.

Intervention Results: The UES model was effective in reducing preventable ED visits and meeting the mental health needs of students in crisis. The study found a decrease in the volume of school referrals to the ED during UES hours of operation, dropping from 80 to 45 pre- and post-pilot, a decrease of 44%. The admission rate of school referrals to the ED during the day shift increased from 4% in 2013 to 11% in 2014, suggesting an increase in the proportion of clinically appropriate ED referrals, with subacute referrals being diverted to the UES.

Conclusion: The study suggests that urgent psychiatric evaluation and care coordination may be an effective model for reducing preventable ED visits and meeting the mental health needs of students in crisis. The authors recommend further analysis of a more fully developed UES with attention to utilization, cost-effectiveness, and the experiences and outcomes for patients, families, and school personnel to justify the model.

Study Design: Observational

Setting: The study was conducted at a large urban hospital in Brooklyn, New York.

Population of Focus: The target audience for the study is mental health professionals, educators, and policymakers interested in improving access to mental health services for school-aged children.

Sample Size: The sample size for the study was 72 students referred to the Urgent Evaluation Service (UES) from January 1 to June 30, 2014.

Age Range: This article focuses on school-age children and adolescents who were referred for behavioral health evaluations and crisis management. This typically encompasses individuals between the ages of 5 to 18 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Family-Based Interventions, Consultation (Parent/Family),

Intervention Description: During infancy, the American Academy of Pediatrics Bright Futures fourth edition health supervision guidelines recommend frequent well-child visits (WCVs) in which providers are expected to screen for and address maternal depression, intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach that implements these recommendations (Developmental Understanding and Legal Collaboration for Everyone; DULCE) with 3 aims for 6-month-old infants and their families: 75% receive all WCVs on time, 95% are screened for 7 HRSNs, and 90% of families with concrete supports needs and 75% of families with maternal depression or IPV receive support. Between January 2017 and July 2018, five DULCE teams (including a community health worker, early childhood system representative, legal partner, clinic administrator, pediatric and behavioral health clinicians) from 3 communities in 2 states participated in a learning collaborative. Teams adapted DULCE using Plan-Do-Study-Act cycles, reported data, and shared learning monthly. Run charts were used to study measures. The main outcome was the percent of infants that received all WCVs on time.

Intervention Results: The percentage of families who completed all WCVs on time increased from 46% to 65%. More than 95% of families were screened for HRSNs, 70% had ≥1 positive screen, and 86% and 71% of those received resource information for concrete supports and maternal depression and IPV, respectively.

Conclusion: Quality improvement-supported DULCE expansion increased by 50% the proportion of infants receiving all WCVs on time and reliably identified and addressed families' HRSNs, via integration of existing resources.

Study Design: Program evaluation

Setting: Three communities from the Early Childhood Learning and Innovation Network for Communities recruited clinics serving predominantly Medicaid-insured patients

Population of Focus: Families with newborns up to 8 weeks of age

Sample Size: Five local DULCE site teams and 692 families with infants

Age Range: Families with infants 0-6 months

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Person-to-Person Education, Peer Counselor, Motivational Interviewing, Telephone Support, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Consultation (Parent/Family)

Intervention Description: The goals were to describe a smoking cessation intervention, the Tennessee Intervention for Pregnant Smokers program, and examine the impact on quit rates compared to usual care. Additionally we sought to examine reduction in smoking levels and number of quit attempts related to the intervention and finally to examine the impact of the intervention on birth outcomes.

Intervention Results: Over 28% of intervention group women quit smoking, compared to 9.8% in the control group. Two thirds of intervention group women significantly reduced smoking by delivery, with 40%+ attempting to quit at least once. Compared to controls, intervention group women saw significantly better birth outcomes, including newborns weighing 270g more and 50% less likely to have a neonatal intensive care unit admission. Among intervention group participants, those who quit smoking had significantly better birth outcomes than those who did not quit smoking.

Conclusion: Findings point to the potential for appropriately tailored pregnancy smoking interventions to produce substantial improvements in birth outcomes within populations with health disparities.

Study Design: RCT

Setting: Prenatal care clinics

Population of Focus: Pregnant women smokers who receive Medicaid and prenatal care

Data Source: Self-report of smoking behavior, exhaled CO, urine cotinine

Sample Size: 1486

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Assessment, Consultation (Parent/Family),

Intervention Description: "The whole health care model embedded monitoring of overall health and wellness education within the center’s outpatient mental and substance use disorder treatment services, and it improved care coordination with primary care providers."

Intervention Results: "For the first two-and-a-half years of the program, Medicare expenditures decreased by $266 per month on average for each enrolled beneficiary in the intervention group relative to the comparison group (p,.01). Intervention clients had .02 fewer hospitalizations, .03 fewer emergency department (ED) visits, and .13 fewer office visits per month relative to the comparison group (p,.05 for all estimates)."

Conclusion: "Overall, the whole health model reduced Medicare expenditures, ED visits, and hospitalization rates. These results may be due in part to the availability of more comprehensive medical data and staff’s improved awareness of client’s overall health needs."

Study Design: The study design was a difference-in-differences model using fee-for-service Medicare administrative claims and enrollment data.

Setting: The setting for the study was a community mental health center.

Population of Focus: The target audience for the study would include healthcare providers, mental health professionals, policymakers, and researchers interested in integrated care models and their impact on service utilization and expenditures.

Sample Size: he sample size for the intervention group was N=846, and the matched comparison group was N=2,643.

Age Range: The age range of the participants was not explicitly mentioned in the provided excerpts.

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Consultation (Parent/Family), Access to Provider through Hotline, PARENT_FAMILY, PATIENT_CONSUMER

Intervention Description: This study describes outcome evaluation results from a dissemination and implementation study of a research-tested program to increase smoke-free home rules through US 2-1-1 helplines.

Intervention Results: A total of 2345 households (335-605 per 2-1-1 center) were enrolled by 2-1-1 staff. Most participants were female (82%) and smokers (76%), and half were African American (54%). Overall, 40.1% (n = 940) reported creating a full household smoking ban. Among the nonsmoking adults reached at follow-up (n = 389), days of SHS exposure in the past week decreased from 4.9 (SD = 2.52) to 1.2 (SD = 2.20). Among the 1148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p < .0001), with no differences by gender. Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies.

Conclusion: Dissemination of this brief research-tested intervention via a national grants program with support from university staff to five 2-1-1 centers increased home smoking bans, decreased SHS exposure, and increased cessation rates. Although the program delivery capacity demonstrated by these competitively selected 2-1-1s may not generalize to the broader 2-1-1 network in the United States, or social service agencies outside of the United States, partnering with 2-1-1s may be a promising avenue for large-scale dissemination of this smoke-free homes program and other public health programs to low socioeconomic status populations in the United States.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, CAREGIVER, Motivational Interviewing/Counseling, Assessment (caregiver), PATIENT/CONSUMER, Educational Material, Online Material/Education/Blogging, Motivational Interviewing, PARENT/FAMILY, Consultation (Parent/Family), Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans.

Intervention Results: When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 or Treatment condition 2. Similarly, no significant differences were detected in the proportion of parent/care givers who reported that they were smokers, or in the proportion of households reported to have a complete smoking ban.

Conclusion: Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.

Study Design: Cluster randomized controlled trial

Setting: Community well-child health clinics

Population of Focus: s Infants exposed to second hand smoke

Data Source: Data was collected via computer during the visit, child health clinic records

Sample Size: 1424 parents of children aged 0 to 4 years attending well-child health checks

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family), , PARENT_FAMILY

Intervention Description: This study assessed to what extent an intervention increased delivery of cessation assistance to breast-feeding mothers who smoke.

Intervention Results: Current breast feeding was associated with a reduced likelihood of current smoking (adjusted odds ratio [aOR] = 0.38, 95% confidence interval [95% CI] = 0.25 to 0.57) and a greater likelihood of quitting smoking (aOR = 2.33, 95% CI = 1.29 to 4.21) after controlling for known confounders. Mothers who concurrently smoked and breast-fed were more likely to be asked about smoking (66.7% vs. 28.6%, p = .01), advised to quit (61.1% vs. 21.4%, p < .01), prescribed nicotine replacement therapy (50.0% vs. 0%, p < .001), and enrolled into the quitline (27.8% vs. 0%, p < .01) at CEASE practices compared to control practices.

Conclusion: Breast-feeding mothers were less likely to be current smokers and more likely to have recently quit smoking. Among mothers who continue to smoke and breast feed, the CEASE intervention enhances delivery of smoking cessation assistance.

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Social Network/Peer, Consultation (Parent/Family),

Intervention Description: Well-child care has suboptimal outcomes regarding adherence to appointments and recall of guidance, especially among families facing structural barriers to health. Group well-child care (GWCC) aims to improve these outcomes by enhancing anticipatory guidance discussions and peer education. We conducted a randomized controlled trial, comparing GWCC with traditional, individual well-child care (IWCC) and assessed health care utilization, immunization timeliness, recall of anticipatory guidance, and family-centered care. Ninety-seven mother-infant dyads were randomized to GWCC or IWCC.

Intervention Results: Compared with IWCC infants, GWCC infants attended more of the 6 preventive health visits (5.41 vs 4.87, P < .05) and received more timely immunization at 6 months and 1 year but did not differ in emergency or hospital admission rates. There were no differences in mothers' reports of anticipatory guidance received or family-centered care.

Conclusion: As primary care is redesigned for value-based care and structural vulnerabilities are considered, GWCC may be a key option to consider.

Study Design: Randomized controlled trial

Setting: Group well-child care at Yale University in New Haven, CT

Population of Focus: English-speaking mother-infant dyads whose babies were born in the Yale New Haven Hospital's well newborn nursery

Sample Size: 97 mother-infant dyads

Age Range: Infants birth to 12 months old and their mothers

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Mentors, Consultation (Parent/Family), Training (Parent/Family),

Intervention Description: The aim of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) study was to evaluate the effects of parent mentors – Latino parents with children covered by Medicaid or the Children’s Health Insurance Program (CHIP) – on insuring Latino children in a community-based trial of uninsured children from 2011-2015. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. The intervention group was assigned parent mentors – trained, fluently bilingual Latino parents who had at least one child insured by Medicaid or CHIP for at least one year. The study team recruited parent mentors from a primary care clinic or a school and via referrals from other mentors. Mentor candidates were screened and interviewed to recruit people characterized by reliability, promptness, organizational skills, persistence, and motivation to help families with uninsured children. The team aimed to match ZIP codes of residence for mentors and participants to promote neighborhood relationships, social support, and economic investment. Mentors were paid $15/hour. Parent mentors attended a two-day training and received training manuals in English and Spanish with 9 training topics and one on sharing experiences. Parents mentors provided 8 services to intervention children and families (e.g., teaching about types of insurance programs and application processes; helping parents complete and submit children’s insurance applications; acting as family advocates by liaising between families and Medicaid or CHIP agencies; and helping parents complete and submit applications for coverage renewal).

Intervention Results: The study found that parent mentors were more effective than traditional methods in insuring children (95% vs. 69%), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100% vs. 70%). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities. Parent mentors, as a special category of community health workers, could be an excellent fit with and complement to current state community health worker models. Kids’ HELP also would seem to be a promising intervention at the federal level, regardless of the outcome of federal debates about Medicaid, CHIP, and future directions and financing of these programs. More covered Latino children, better outcomes, reduced costs, higher care quality, improved parental satisfaction, and job creation would seem to constitute a potent combination of benefits for the nation. This RCT documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of wellchild and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, ad creates jobs. Kids’ HELP could be implemented as part of existing state community health worker models and federal Medicaid and CHIP outreach and enrollment grants.

Conclusion: A rigorous randomized controlled trial documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of well-child and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, and creates jobs. Kids’ HELP could be implemented as part of existing state community health worker models and federal Medicaid and CHIP outreach and enrollment grants.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Parents and Children

Sample Size: 155 subjects (children and parents); 75 in the control group and 80 in the intervention group)

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Access to Provider through Hotline, Consultation (Parent/Family), PARENT_FAMILY, PATIENT_CONSUMER

Intervention Description: This study compared enrollment of parents who smoke in the quitline using electronic referral with that using manual referral.

Intervention Results: During the study period, in the eReferral group, 10.3% (24 of 233) of parents who smoked and were interested in quitting enrolled in the quitline, whereas only 2.0% (5 of 251) of them in the control group enrolled in the quitline-a difference of 8.3% (95% CI=4.0, 12.6). Parents aged ≥50 years enrolled in the quitline more frequently. Although more parents in the eReferral group connected to the quitline, among parents who had at least one quitline contact, there was no significant difference in the mean number of quitline contacts between eReferral and control groups (mean, 2.04 vs 2.40 calls; difference, 0.36 [95% CI=0.35, 1.06]).

Conclusion: Smoking parent eReferral from pediatric primary care may increase quitline enrollment and could be adopted by practices interested in increasing rates of parent treatment.

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family),

Intervention Description: provider recommendation

Intervention Results: Approximately 70% of children had a parent report receiving a provider recommendation for influenza vaccination for their child. - The strongest association between receipt of provider recommendation and demographic characteristics was with child’s age, with younger children (6–23 months, 2–4 years, and 5–12 years) being more likely to have a provider recommendation than older children (13–17 years). - Children living in a household above poverty with household income >$75,000 were more likely to have a parent report receipt of a provider recommendation than children living below poverty. - Children with a provider recommendation were twice as likely to be vaccinated than those without. The study found that children for whom a parent reported receipt of a provider recommendation were approximately twice as likely to be vaccinated compared with children whose parent did not report receiving a provider recommendation 5. This indicates an increased uptake of influenza vaccination among children who received a provider recommendation.

Conclusion: The study highlights the strong relationship between a provider recommendation and influenza vaccination among children and identifies groups of children for whom improvements in provider recommendations are needed, notably older children and children living below poverty.

Study Design: The study was a cross-sectional survey.

Setting: The study was conducted in the United States.

Population of Focus: The target audience was parents or guardians of children aged 6 months to 17 years.

Sample Size: The sample size was 8,383 parents or guardians of children aged 6 months to 17 years.

Age Range: The age range of the children included in the study was 6 months to 17 years.

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Adult-led Support/Counseling/Remediation, PARENT/FAMILY, CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling, Consultation/Counseling (Parent/Family), Counseling (Parent/Family)

Intervention Description: To determine whether repeated infancy-onset lifestyle counselling alters parental smoking and children's exposure to tobacco smoke.

Intervention Results: Parents' smoking decreased during the study similarly in the intervention and control groups. Of the 8-y-old children, 46% had detectable serum cotinine concentration, suggesting exposure to tobacco smoke during the past few days. All children were non-smokers. Serum cotinine concentrations did not differ between the intervention and control children. Children's cotinine values were highest in the families where either father or both parents were smokers.

Conclusion: Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents. However, counselling led to no differences in parental smoking between the two groups, or in exposure of the intervention and control children to tobacco smoke. This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children's tobacco smoke exposure.

Study Design: Randomized prospective intervention trial

Setting: Pediatric well-child visits

Population of Focus: Families presenting at a well-baby clinic with a child 5 months old.

Data Source: Cotinine measurements of mothers, fathers, and children; Reported smoking of parents during annual office visit to pediatrician (via questionnaires and interviews)

Sample Size: 1062 families (Intervention= 540; Control = 522)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Peer Counselor, Telephone Support, Other Education, Motivational Interviewing, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Motivational Interviewing/Counseling, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Consultation/Counseling (Parent/Family), Counseling (Parent/Family)

Intervention Description: We hypothesized that a multilevel treatment model integrating pediatric clinic-level AAR with individual-level, telephone counseling would promote greater long-term (12-month) child TSE reduction and parent smoking cessation than clinic-level AAR alone.

Intervention Results: Child TSE (urine cotinine) declined significantly in both intervention and control groups from baseline to 12-months with no between-group differences. There was s statistically significant effect on 12-month bioverified quit status-intervention group participants were 2.47 times more likely to quit smoking than those in the control group.

Conclusion: Pediatrician advice alone may be sufficient to increase parent protections of children from TSE. Integrating clinic-level intervention with more intensive individual-level smoking intervention is necessary to promote parent cessation.

Study Design: RCT

Setting: Telephone counseling

Population of Focus: Parents/caregivers

Data Source: Self-reported interview data

Sample Size: 327 were randomized (164-control and 163-intervention)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family), Educational Material,

Intervention Description: Team discussions and staff training, reminder mailings to parents and guardians of patients aged 9 through 12 years, pictures and information provided for utilization in patient rooms

Intervention Results: There was slight improvement in all age ranges and genders in HPV vaccination rates after the intervention, but there is a need for more tightly controlled methods to determine the effectiveness of intervention and of specific measures.

Conclusion: Sustainable methods for vaccine promotion and clinical intervention must be implemented for long-term benefit, and missed opportunities to vaccinate must be addressed.

Study Design: Retrospective assessment of HPV vaccination data before and after intervention - Intervention description: Team discussions and staff training, reminder mailings to parents and guardians of patients aged 9 through 12 years, pictures and information provided for utilization in patient rooms

Setting: Outpatient pediatric clinic in Omaha, Nebraska metropolitan area

Population of Focus: Adolescents aged 9 through 18 years old

Sample Size: N = 3393 subjects at baseline between 9 and 17 years of age

Age Range: 9 through 18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Motivational Interviewing/Counseling, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Consultation/Counseling (Parent/Family), Counseling (Parent/Family), Educational Material (caregiver)

Intervention Description: Children with asthma who are exposed to environmental tobacco smoke are at increased risk for adverse health consequences. An experimental design was used to evaluate a minimal-contact intervention aimed at modifying parents' smoking behavior in their homes.

Intervention Results: More treatment (35%) than control (17%) subjects reported smoking outside their homes at posttest (and their children’s cotinine levels were lower), but this difference was not statistically significant.

Conclusion: difference was not statistically significant.

Study Design: Experimental design

Setting: Pediatric pulmonary clinics in U of MI

Population of Focus: Parents of children with asthma

Data Source: Parent questionnaire on smoking status and child urine sample.

Sample Size: 92 families randomly assigned

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family), Family-Based Interventions, Provider/Patient Communication Portal,

Intervention Description: N/A

Intervention Results: In multivariate analyses, there were no significant differences in access to care according to parental citizenship status. Children with 2 noncitizen parents had fewer doctor visits and were less likely to go to the emergency department in the past year than those with 2 citizen parents. Among children with 1 or 2 noncitizen parents, their parents reported worse experiences in care than those with 2 citizen parents. Similar results were observed for language use. Parents of children in bilingual and Spanish-only households were less likely to report that their children's doctors explained things clearly, and parents in Spanish-only households were less likely to communicate via telephone or e-mail than those in English-only households.

Conclusion: Health policy should focus on provider-parent communication to ensure health care equity for Latino children whose parents are not citizens or do not speak English.

Study Design: Analyses were conducted to determine the associations between access (usual of source of care, delay in receiving needed care, health insurance), utilization (physician visits in past year, emergency department visits), and experiences (doctor listens, doctor explains instructions clearly, communication via telephone or e-mail) according to parental citizenship status and household language use after adjusting for confounders.

Setting: 2011 and 2012 California Health Interview Survey; California

Population of Focus: Latinx children

Sample Size: 2841

Age Range: <12

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (Provider), Consultation (Parent/Family), Education on Disease/Condition,

Intervention Description: The intervention consisted of a five-component toolkit aimed at improving healthcare providers' communication skills about HPV vaccination. The components included: (1) making presumptive and strong recommendations, (2) using motivational interviewing techniques, (3) providing a fact sheet, (4) showing disease images, and (5) using a website.

Intervention Results: - Providers in the intervention group reported higher use of the intervention components, including making presumptive and strong recommendations and using motivational interviewing techniques. - Use of the fact sheet was significantly correlated with high parental acceptance of the HPV vaccine. - Providers in the intervention group did not report spending more time discussing the vaccine with hesitant parents than control providers. - Providers in the intervention group reported greater improvement in parental HPV vaccine acceptance than control providers. The study found that the intervention resulted in substantial improved HPV vaccine series initiation and completion among adolescents in the intervention arm compared to controls. Providers in the intervention group reported greater improvement in parental HPV vaccine acceptance than control providers. However, the change in parental vaccine acceptance over time was not statistically significant between groups.

Conclusion: Communication-based interventions, such as the five-component toolkit used in this study, have the potential to increase HPV vaccination rates among adolescents. - Future research should examine the effectiveness of a streamlined version of the intervention, focusing on communication skills training and fact sheets.

Study Design: The study used a randomized controlled trial design.

Setting: The study was conducted in a central Colorado practice-based research network.

Population of Focus: Healthcare providers who work with adolescent patients.

Sample Size: The study included 187 providers from 16 practices (8 intervention, 8 control).

Age Range: The study focused on adolescent patients who were eligible for HPV vaccination.

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family), Financial Incentives, Referrals,

Intervention Description: Poverty is a common root cause of poor health and disrupts medical care. Clinically embedded antipoverty programs that address financial stressors may prevent missed visits and improve show rates. This pilot study evaluated the impact of clinic-based financial coaching on adherence to recommended preventive care pediatric visits and vaccinations in the first 6 months of life. In this community-partnered randomized controlled trial comparing clinic-based financial coaching to usual care among low-income parent-infant dyads attending pediatric preventive care visits, we examined the impact of the longitudinal financial intervention delivered by trained coaches addressing parent-identified, strengths-based financial goals (employment, savings, public benefits enrollment, etc.). We also examined social needs screening and resource referral on rates of missed preventive care pediatric visits and vaccinations through the 6-month well-child visit.

Intervention Results: Eighty-one parent-infant dyads were randomized (35 intervention, 46 control); nearly all parents were mothers and more than one-half were Latina. The rate of missed visits among those randomized to clinic-based financial coaching was half that of controls (0.46 vs 1.07 missed of 4 recommended visits; mean difference, 0.61 visits missed; P = .01). Intervention participants were more likely to have up-to-date immunizations each visit (relative risk, 1.26; P = .01) with fewer missed vaccinations by the end of the 6-month preventive care visit period (2.52 vs 3.8 missed vaccinations; P = .002).

Conclusion: In this pilot randomized trial, a medical-financial partnership embedding financial coaching within pediatric primary care improved low-income families' adherence to recommended visits and vaccinations. Clinic-based financial coaching may improve care continuity and quality in the medical home.

Study Design: Randomized controlled trial

Setting: Pediatric primary care clinic at Harbor-UCLA, an academically affiliated safety net medical center and second largest in Los Angeles County’s Department of Health Services

Population of Focus: Low-income parent-infant dyads presenting to pediatric primary care clinics for scheduled, non-acute primary care visits

Sample Size: 81 parent-infant dyads, with 35 dyads assigned to the intervention group receiving clinic-based financial coaching and 46 dyads assigned to the control group receiving usual care

Age Range: The participants included English- and Spanish-speaking adult parents and their infants younger than 4 months of age