Improving access to peer-to-peer support for caregivers of children and youth with special health care needs: a quality improvement project

Abstract

Caregivers of children and youth with special health care needs (CYSHCN) experience stress, burden, and social isolation, which are powerful predictors of poor health outcomes for both the caregivers and their children. Supporting caregivers of CYSHCN in a clinical setting is critical in holistically supporting a CYSHCN medical home. The Montana Parent Partner Program (MTPPP) is an evidence-informed peer-to-peer support opportunity aimed at improving health and social outcomes for caregivers. This program is funded by the Department of Public Health and Human Services (DPHHS) and is available to Montana health care clinics that serve the CYSHCN at no cost to the clinic. At the selected practice site location (PSL), the referral rate and enrollment rate to the program were low; in November and December 2021, only two enrollments were completed into the program out of the 66 patients evaluated aged 0-21 years--a total enrollment rate of 3%. The referral rate was not historically tracked. DPHHS, the PSL, and the MTPPP partnered together in a quality improvement (QI) effort to achieve a referral rate into the MTPPP between January and February 2022 of 50%. The QI team identified barriers to referring and enrolling caregivers into the MTPPP and subsequently proposed opportunities for improvement to reach their goal. First, the team aimed to educate providers at the PSL on the evidence, benefits, and services of the MTPPP. Once the team expressed increased confidence in referring patients to the program, the team re-developed the workflow, referral, consent, and enrollment process and integrated information technology to streamline the processes. Regular PDSA cycles were used in meetings to elicit feedback and address barriers. The results established a referral rate of 40% and an increased enrollment rate of 14% from the previous two months. The findings of this effort can inform current MTPPP hosts and future practices to utilize the PDSA cycle to improve processes. Although the results are affirmative, more time should be dedicated to the quality improvement effort, allowing for more data collection and PDSA cycle completions.