Primary Submission Category: Interventions/Programs
Mixed methods evaluation of an early childhood CHW program in a large public hospital system in New York City
Authors: Rachel Massar, Renata Howland, Katherine Piwnica-Worms, Nithya Narayanan, Kayla Fennelly, Arya Singh, Ariel Charney, Shauntee Henry, John Billings, Carolyn Berry,
Presenting Author: Lorraine Kwok*
In 2021, NYC Health + Hospitals (H+H), the largest public hospital system in the US, launched an Early Childhood Community Health Worker (EC CHW) program in 16 pediatric primary care facilities with a focus on increasing access to Early Intervention (EI) and addressing social needs. We conducted a mixed methods evaluation to assess implementation and program outcomes. Key informant interviews were conducted with program staff at 5 facilities, Central Office leadership, and caregivers and analyzed using rapid qualitative methods. Pre/post caregiver surveys (baseline, 3 months) assessed self-reported health, parenting self-efficacy, engagement with child’s healthcare, social needs, and clinic/program satisfaction. We assessed impact on mother-child dyads by linking program participants with NYS Medicaid claims (n=7,516) and selected a comparison group of children receiving care at similar NYC safety net providers (n=18,158) using matching methods based on child and maternal characteristics. We estimated the effect of the EC CHW program on any use of EI evaluation and services in the 12-months following program enrollment using logistic regression models. Qualitative interviews revealed key facilitators and barriers to effective program implementation. Caregivers reported significant increases in engagement with their children’s healthcare and parenting self-efficacy, as well as high satisfaction with their clinic/EC CHW program. Medicaid claims analyses found children in the EC CHW program were 15.7 percentage points (pp) more likely to have an EI evaluation compared to children in the comparison group (21.4% vs. 5.7%). EC CHW children were also 9.7 pp more likely to receive EI services compared to children in the comparison group (15.2% vs. 5.5%). Results from our evaluation of the EC CHW program at H+H can inform program development, implementation, expansion, and sustainability of similar CHW programs across the country.