Building healthy children: evidence-based home visitation integrated with pediatric medical homes.

BACKGROUND AND OBJECTIVES The Building Healthy Children (BHC) collaborative has successfully integrated home visitation into medical care of infants born to young, low-income mothers. Patients receive parenting education, and therapy for parent-child trauma and maternal depression through home visitation. The goals are to avoid child maltreatment, improve parent and child health, and enhance family functioning. METHODS This randomized trial tests combining 3 evidence-based services versus screening and referral to community services only. Patients of 3 primary care practices are screened for eligibility (no previous Child Protective Services indication, maternal age <21 at first delivery, and ≤2 children younger than age 3). Treatment families receive Parents as Teachers, child-parent psychotherapy, and interpersonal psychotherapy as needed. Outreach workers assist with concrete needs, including transportation to medical visits. Participant evaluations and reviews of pediatric medical charts are performed at regular intervals. Electronic medical record communications and BHC social workers ensure full integration with the medical home. RESULTS Of all eligible families approached, 75% (n = 497) enrolled in BHC and 85% remained enrolled by age 3. At baseline, 37% of mothers were victims of child abuse/neglect, 22% showed significant depressive symptoms, and 59% of children were exposed to domestic violence. Preliminary analyses demonstrate avoidance of indicated Child Protective reports and foster placement and high rates of preventive care for enrolled children. CONCLUSIONS BHC offers a unique model of evidence-based home visiting services integrated into primary care. This promising program demonstrates high retention rates and addresses the multidimensional needs of young at-risk families.