Medical homes for at-risk children: Parental reports of clinician-parent relationships, anticipatory guidance, and behavior changes

Catherine S. Nelson, Susan Higman, Calvin Sia, Elizabeth C McFarlane, Loretta Fuddy, Anne K Duggan

Research output: Contribution to journalArticle

Abstract

Background. Family-centeredness, compassion, and trust are 3 attributes of the clinician-parent relationship in the medical home. Among adults, these attributes are associated with patients' adherence to clinicians' advice. Objectives. The objectives were (1) to measure medical home attributes related to the clinician-parent relationship, (2) to measure provision of anticipatory guidance regarding injury and illness prevention, (3) to relate anticipatory guidance to parental behavior changes, and (4) to relate medical home attributes to anticipatory guidance and parental behavior changes. Methods. A cross-sectional study of data collected among at-risk families when children were 1 year of age, in a randomized, controlled trial of a home-visiting program to prevent child abuse and neglect, was performed. Modified subscales of the Primary Care Assessment Survey were used to measure parental ratings of clinicians' family-centeredness, compassion, and trust. Parental reports of provision of anticipatory guidance regarding injury and illness prevention topics (smoke alarms, infant walkers, car seats, hot water temperature, stair guards, sunscreen, firearm safety, and bottle propping) and behavior changes were recorded. Results. Of the 564 mothers interviewed when their children were 1 year of age, 402 (71%) had a primary care provider and had complete data for anticipatory guidance items. By definition, poverty, partner violence, poor maternal mental health, and maternal substance abuse were common in the study sample. Maternal ratings of clinicians' family-centeredness, compassion, and trust were fairly high but ranged widely and varied among population subgroups. Families reported anticipatory guidance for a mean of 4.6 ± 2.2 topics relevant for discussion. Each medical home attribute was positively associated with parental reports of completeness of anticipatory guidance, ie, family-centeredness (β = .026, SE = .004), compassion (β = .019, SE = .005), and trust (β = .016, SE = .005). Parents' perceptions of behavior changes were positively associated with trust (β = .018, SE = .006). Analyses were adjusted for potential confounding by randomized, controlled trial group assignment, receipt of ≥5 well-child visits, and baseline attributes. Conclusions. Among at-risk families, we found an association between parental ratings of the medical home and parental reports of the completeness of anticipatory guidance regarding selected injury and illness prevention topics. Parents' trust of the clinician was associated with parent-reported behavior changes for discussed topics.

Original languageEnglish (US)
Pages (from-to)48-56
Number of pages9
JournalPediatrics
Volume115
Issue number1
DOIs
StatePublished - Jan 2005

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Patient-Centered Care
Child Abuse
Mothers
Primary Health Care
Wounds and Injuries
Randomized Controlled Trials
Parents
Infant Equipment
Sunscreening Agents
Firearms
Poverty
Patient Compliance
Violence
Smoke
Substance-Related Disorders
Mental Health
Cross-Sectional Studies
Hot Temperature
Safety
Water

Keywords

  • Anticipatory guidance
  • At-risk families
  • Behavior changes
  • Clinician-parent relationship
  • Compassion
  • Family-centered
  • Medical home
  • Trust

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Medical homes for at-risk children : Parental reports of clinician-parent relationships, anticipatory guidance, and behavior changes. / Nelson, Catherine S.; Higman, Susan; Sia, Calvin; McFarlane, Elizabeth C; Fuddy, Loretta; Duggan, Anne K.

In: Pediatrics, Vol. 115, No. 1, 01.2005, p. 48-56.

Research output: Contribution to journalArticle

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T2 - Parental reports of clinician-parent relationships, anticipatory guidance, and behavior changes

AU - Nelson, Catherine S.

AU - Higman, Susan

AU - Sia, Calvin

AU - McFarlane, Elizabeth C

AU - Fuddy, Loretta

AU - Duggan, Anne K

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N2 - Background. Family-centeredness, compassion, and trust are 3 attributes of the clinician-parent relationship in the medical home. Among adults, these attributes are associated with patients' adherence to clinicians' advice. Objectives. The objectives were (1) to measure medical home attributes related to the clinician-parent relationship, (2) to measure provision of anticipatory guidance regarding injury and illness prevention, (3) to relate anticipatory guidance to parental behavior changes, and (4) to relate medical home attributes to anticipatory guidance and parental behavior changes. Methods. A cross-sectional study of data collected among at-risk families when children were 1 year of age, in a randomized, controlled trial of a home-visiting program to prevent child abuse and neglect, was performed. Modified subscales of the Primary Care Assessment Survey were used to measure parental ratings of clinicians' family-centeredness, compassion, and trust. Parental reports of provision of anticipatory guidance regarding injury and illness prevention topics (smoke alarms, infant walkers, car seats, hot water temperature, stair guards, sunscreen, firearm safety, and bottle propping) and behavior changes were recorded. Results. Of the 564 mothers interviewed when their children were 1 year of age, 402 (71%) had a primary care provider and had complete data for anticipatory guidance items. By definition, poverty, partner violence, poor maternal mental health, and maternal substance abuse were common in the study sample. Maternal ratings of clinicians' family-centeredness, compassion, and trust were fairly high but ranged widely and varied among population subgroups. Families reported anticipatory guidance for a mean of 4.6 ± 2.2 topics relevant for discussion. Each medical home attribute was positively associated with parental reports of completeness of anticipatory guidance, ie, family-centeredness (β = .026, SE = .004), compassion (β = .019, SE = .005), and trust (β = .016, SE = .005). Parents' perceptions of behavior changes were positively associated with trust (β = .018, SE = .006). Analyses were adjusted for potential confounding by randomized, controlled trial group assignment, receipt of ≥5 well-child visits, and baseline attributes. Conclusions. Among at-risk families, we found an association between parental ratings of the medical home and parental reports of the completeness of anticipatory guidance regarding selected injury and illness prevention topics. Parents' trust of the clinician was associated with parent-reported behavior changes for discussed topics.

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