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Connecting to Early Intervention Services After Neonatal Intensive Care Unit Discharge in a Medicaid Sample

  • Ashwini Lakshmanan
    Correspondence
    Address correspondence to Ashwini Lakshmanan, MD, MS, MPH, Division of Neonatal Medicine, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, Los Angeles, CA 90027
    Affiliations
    Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif

    Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California (A Lakshmanam), Los Angeles, Calif

    Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (A Lakshmanam), Los Angeles, Calif
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  • Isabel Sunshine
    Affiliations
    Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
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  • Cindy M. Escobar
    Affiliations
    Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
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  • Michele Kipke
    Affiliations
    Division of Research on Children, Youth and Families, Children's Hospital, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif

    Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif
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  • Douglas Vanderbilt
    Affiliations
    Section of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (D Vanderbilt), Los Angeles, Calif
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  • Philippe S. Friedlich
    Affiliations
    Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
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  • Christine B. Mirzaian
    Affiliations
    Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (CB Mirzaian), Los Angeles, Calif
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Published:October 28, 2021DOI:https://doi.org/10.1016/j.acap.2021.10.006

      Abstract

      Objective

      To describe caregiver perspectives regarding connecting to early intervention (EI) services after neonatal intensive care unit discharge in a Medicaid sample.

      Methods

      Open-ended semistructured interviews and focus groups were conducted with English- or Spanish-speaking families enrolled in Medicaid in an urban high-risk infant follow-up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis.

      Results

      Thirty-two participants completed the study. The infant's median (interquartile range) birth weight was 1365 (969, 2800) grams; 50% were Hispanic; 31% reported living in a neighborhood with fourth quartile economic hardship. Eighty-one percent were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm and 63% had a diagnosis of developmental delay. A conceptual model was constructed and the analysis revealed major themes describing families’ challenges and ideas to facilitate connection to EI. We identified subthemes related to the person in environment: health care environment/support and socio-economic resources, parent perspectives and built environment; provider level factors such as appointment scheduling, staff limitations, and parent suggestions to improve health care and service navigation, which included improved information sharing, the importance of patient advocates, video resources, early referrals to EI facilitated by the discharging hospital and system workarounds.

      Conclusions

      The results from this study may provide a granular roadmap for providers to help facilitate referrals to EI services. We identified several ideas such as using advocates and providing transitional resources, including online media, that might improve the connection to EI services.

      Keywords

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