Abstract
Problem:
Children under age 2 years are at a critically sensitive developmental stage (Center on the Developing Child at Harvard University, 2016) and poverty and other forms of toxic stress or adverse childhood experiences (ACEs) can have long-term impacts on brain development and future functioning (Felitti, et al., 1998; Developing Child, Harvard University, 2019). Programs targeting improved parent-child interactions can ameliorate long-term impact of early parenting and developmental risks (Center on the Developing Child, 2016; IOM, 2000; National Center for Poverty Parenting Programs, 2020; Weisleder, 2016).
Goals and objectives:
The TREEHOUSE Program will increase access to quality preventive care and services to promote health equity and enhance population health among very young children, and their families, in underserved, low-income communities by:1) Increasing pediatric provider capacity to address patient developmental and social-emotional needs; 2) Improving the quality of parent-child interactions; 3) Increasing knowledge of and referral to community-based resources to support families; and, 4) Strengthening cross-agency partnerships to create an improved system of support for families with young children.
Methodology:
The Institute for Innovation & Implementation (The Institute) at the University of Maryland, Baltimore will collaborate with the Maryland Chapter of the American Academy of Pediatrics (MDAAP) to implement The TREEHOUSE Program, training an estimated 45 pediatric practices to provide developmental telehealth coaching to 450 low-income (Medicaid enrolled) families with young children across a 5-year period. Coaching will be delivered utilizing a Quality Improvement Data Aggregator learning module, developed with the American Academy of Pediatrics Section on Quality Improvement, with continuing education credits.COORDINATION:The TREEHOUSE Program will recruit pediatric providers serving low-income families across Maryland, with a focus on providers serving Medicaid recipients in rural and urban areas. The TREEHOUSE Advisory Board will include representatives from the Maryland Department of Health's Maternal & Child Health Bureau, the Maryland State Department of Education, family members, general and developmental pediatricians, and local and state organizations that serve and advocate for families with young children with the intention of growing statewide and local partnerships leading to increased referrals to family services.
Evaluation:
The TREEHOUSE Program aligns with Maryland's Maternal & Child Health Priorities and will address the HTPCP priorities of Early Childhood Development/School Readiness, Access to Care, Leveraging Partnerships, and Developmental and Behavioral Pediatrics. Performance and outcome measures will be tracked through both qualitative and quantitative measures, with continuous quality improvement activities supporting implementation and enabling mid-course corrections as necessary. The outcomes will be disseminated locally and nationally, with findings leveraged to support ongoing sustainability.