Implementing an Intervention to Address Social Determinants of Health in Pediatric Practices

The investigators prior work has focused on developing a pediatric primary care-based
intervention, "WE CARE (Well-child care visit, Evaluation, Community Resources, Advocacy,
Referral, Education)," aimed at addressing poor families' material needs - food security,
employment, parental education, housing stability, household heat, and childcare - by
systematically screening for these needs and referring families to existing community-based
services. To date, the investigators have tested WE CARE primarily in community health
centers (CHCs); their randomized controlled trial (RCT) demonstrated WE CARE's efficacy on
parental receipt of community-based resources. However, over 80% of low-income children
receive care from providers in traditional pediatric practices (i.e. non-CHCs). The
investigators therefore will conduct a large-scale, Hybrid Type 2
effectiveness-implementation trial in eighteen pediatric practices in the US. A stepped wedge
study cluster RCT design will be used to implement WE CARE in all practices using two common
strategies used to integrate systems-based interventions into primary care - a previously
facilitated "on-site" strategy in which content experts provide training sessions and
on-going consultation; and a self-directed "web-based" method modeled after the American
Academy of Pediatrics' practice transformation strategy. The proposed study's specific aims
are to: 1) demonstrate the non-inferiority of the self-directed, web-based strategy for
implementing WE CARE, in comparison to the facilitated on-site strategy; 2) demonstrate WE
CARE's effectiveness on increasing parental receipt of community resources; and 3) assess the
sustainability of WE CARE in pediatric practices. The investigators hypothesize that WE CARE
will have equivalent fidelity via the two strategies. Based on prior work, the investigators
hypothesize that WE CARE will significantly increase parental receipt of community resources
three months post-visit compared to usual care. The investigators also expect WE CARE to be
sustained 1.5-, 2-, and 2.5-years post-implementation; they expect to gather data from over
2,700 chart reviews, 2,520 parent-child dyads, and 360 providers and office staff. This
proposal has significant public health implications for the delivery of primary care to
low-income children.

Inclusion Criteria:

- Parents/legal guardians (aged at least 18 years) of children aged 2 months through 10
years whose child presents for a health supervision visit

Exclusion Criteria:

- Foster parents, parents who speak neither English or Spanish, and previously enrolled
parents