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Expanding developmental and behavioral services for newborns in primary care: implications of the findings
Robert S Thompson1, David M Lawrence, Colleen E Huebner
1Center for Health Studies and Department of Preventive Care, Group Health Cooperative, Seattle, WA 98101, USA. thompson.rs@ghc.org
Insights
Developmental and behavioral services integrated into primary care significantly improved parental satisfaction and parenting practices for all families. This program demonstrates a viable model for widespread implementation in pediatric healthcare settings.
Area of Science:
- Pediatric healthcare
- Developmental and behavioral sciences
- Public health interventions
Background:
- Previous studies outlined the rationale, development, and early results of integrating developmental and behavioral services into primary care.
- Positive early outcomes included enhanced parental satisfaction, improved parenting practices, and better health outcomes.
Purpose of the Study:
- To review the results of a program delivering developmental and behavioral services in primary care.
- To discuss the implications of these findings for healthcare delivery, families, systems, and future research.
Main Methods:
- Review of findings from a program integrating developmental and behavioral services into primary care.
- Analysis of implications for various stakeholders including families, healthcare systems, and policymakers.
Main Results:
- Developmental and behavioral services can be successfully delivered in primary care settings by dedicated professionals.
- The 'planned care model' facilitated program implementation, making desired actions easier to perform.
- Focus on satisfaction and cost supports the 'business case' for large-scale adoption.
- Parental bonding with organizations has marketing benefits.
- The program benefits all parents, not exclusively high-risk groups.
- Emerging research questions include the long-term effects on health outcomes, costs, and service utilization.
Conclusions:
- Study results have significant implications for preventive services, family support, pediatric office-based care, healthcare systems, and policy.
- Further investigation into intervention effects at 30 months of age is planned.
- Continued research is necessary to determine the viability of these interventions as ongoing programs.
Background:
In two other papers in this issue, the rationale, development, implementation, experimental design, approach to evaluation, and early results of a program to deliver developmental and behavioral services to all infants in primary care practice were described. Positive effects were seen for parental satisfaction, including decreased disenrollment, provider satisfaction, parenting practices, and health outcomes.
Methods:
In the present article, the results are reviewed and implications of our findings for the delivery of care, families, healthcare systems, and further research are discussed.
Results:
Findings that have broad implications are as follows: (1) developmental and behavioral services can be delivered successfully in practice using dedicated professionals to deliver and integrate services; (2) the "planned care model" was useful in program implementation for making "the right thing to do, the easy thing to do"; (3) the added focus on satisfaction and cost helps to develop the "business case" for broad scale implementation; (4) bonding of parents to organizations has marketing implications; (5) the program provides positive effects for all parents, not just high-risk parents; and (6) several research questions emerge, including persistence of effects on health outcomes, costs, and utilization.
Conclusions:
The authors conclude that study results have implications for preventive services, families, child healthcare in office practice, healthcare systems, and healthcare policy. In this ongoing study, examination of intervention effects at 30 months of age shoud be informative. Further research is warranted as it remains to be seen whether or not these interventions can become viable ongoing programs.
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