A Randomized Controlled Trial of Group Versus Individual Well Child Care for High-risk Children: Maternal-Child Interaction and Developmental Outcomes

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Abstract
Objective. To determine if group well child care (GWCC) for high-risk children affects maternal-child interaction and development as compared to these outcomes in children receiving traditional individual well child care (IWCC). Study Design. Randomized controlled trial. Participants. Infants less than 4 months old at the initiation of the study who came from high-risk families. Families were classified as high risk, and eligible for study participation, if the mother had one or more of the following characteristics: poverty, single marital status, less than a high school education, age less than 20 years at delivery, previous substance abuse, or a history of abuse as a child. Setting. Two urban, university pediatric clinics in Seattle, Washington. Interventions. Study children were randomized to receive GWCC or IWCC prior to the first study visit at the age of 4 months. Study health supervision visits were scheduled at 4, 5, 6, 8, 10, 12, and 15 months of age. For children randomized to receive GWCC, study visits consisted of an age-matched group discussion of child rearing issues, either preceding or following a brief physical examination. After the 15-month visit, development of study patients was assessed by the use of Bayley Scales of Infant Development (Bayley). Maternal-child interaction and the home environment were evaluated by the use of the Nursing Child Assessment Teaching Scale (NCATS) and the Home Observation for Measurement of the Environment (HOME), respectively. Results. At least one outcome measure was obtained on 114 children; 86 patients completed all three outcome measures. Bayley psychomotor mean scores were 103.6 ± 11.5 for GWCC patients versus 100.0 ± 12.4 for those receiving IWCC (P= .14); mean scores for the mental section were 99.3 ± 14.8 and 100.4 ± 14.3, respectively (P = .71). The prevalence of high-risk maternal-child interactions was 10% in both the GWCC and IWCC groups. A high-risk home environment was found in 16% of IWCC patients versus 4% of those randomized to GWCC (odds ratio comparing IWCC to GWCC 4.6, 95% confidence interval 0.78, 26.0, after controlling for confounding variables). Provider time was similar among groups (mean number of minutes/patient/study visit: 19.8 ± 5.6 and 20.4 ± 6.7 for GWCC and IWCC, respectively,P = .66). Conclusion. GWCC is a viable alternative to IWCC for high-risk children. Developmental outcomes and maternal-child interaction are at least as good for children who received GWCC as compared to traditional IWCC, without any increase in provider time required. well child care, child development, maternal-child interaction, Bayley Scales of Infant Development, Nursing Child Assessment Teaching Scale, Home Observation for Measurement of the Environment.