Introduction: Few eligible children participate in early intervention (El) programs. The objective of this study was to determine feasibility and outcomes of a novel patient navigation program on El referrals among a diverse group of at-risk children. Methods: During a 6-month period, a patient navigator was assigned to an urban pediatric clinic to engage families, provide education on early child development and El, and assist families with completing multidisciplinary evaluations. Families were eligible to participate if they spoke English, had a child <34 months old with a suspected developmental delay, and were referred to El for evaluation. Families completed measures of demographics, language preference, and the Newest Vital Sign, a validated literacy measure. Outcomes on completion of El referrals were obtained from the county El provider. Results: Of 88 El referrals during the study period, 53 patients were eligible and enrolled. Patients were predominantly male, racially diverse, on public health insurance, with a mean age of 18.4 months. Most caregivers of patients had less than a high school education, spoke a non-English language at home, and had limited literacy. Forty-two families (79.2%) completed a referral, and 34 (81.0%) of those were eligible for El services. There were no significant differences in demographic, language, or literacy measures between those who completed and did not complete El referrals. Discussion: A patient navigation program to facilitate El referrals was feasible in a diverse urban patient population. Preliminary results of the patient navigation program on El referral completion were promising and warrant further study.
Keywords: child development, patient navigation, early intervention (education)
Developmental delays are common among young children (Rosenberg, Zhang, & Robinson, 2008). Delayed development occurs when a young child does not reach important developmental milestones within an expected period of time in one or more domains (Committee on Children With Disabilities, American Academy of Pediatrics, 2001) Identifying delays and instituting early intervention (El) services in a timely fashion can optimize child health (Shonkoff & Phillips, 2000). Unfortunately, few eligible children participate in El programs nationwide, and this is particularly true for poor racial minority children (McManus, McCormick, Acevedo-Garcia, Ganz, & Hauser-Cram, 2009).
Patient navigators have been utilized to provide patients at risk for delays in care with emotional support, instrumental and technical assistance to overcome barriers, and health education in a culturally sensitive manner (Baker-Ericzen, Mueggenborg, Hartigan, Howard, & Wilke, 2008; Jean-Pierre et al., 2012). The aim of this brief report was to develop and test the feasibility of a novel patient navigation intervention, the Opening Doors to Early Intervention Program, for children who had been identified with developmental delays.
We recruited a single urban primary care pediatric practice in Philadelphia. The practice employed 19 pediatricians and nurse practitioners and a social worker and was a continuity clinic training site for residents from the Children's Hospital of Philadelphia (CHOP). The practice population was ethnically diverse: 21% Hispanic, 36% Black, 35% White, and 8% Asian. Most children attending the practice received public health insurance, whereas nearly 40% spoke a language other...