Family Partner Navigation for Children

NCT ID: NCT03569449

Last Updated: 2025-11-26

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

312 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-06-24

Study Completion Date

2024-06-21

Brief Summary

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Family Navigation (FN), an evidence-based care management strategy which is a promising intervention to help low income and minority families access timely mental health services. Despite significant evidence supporting the effectiveness of FN, concerns exist about the ability to disseminate FN to a broad population due to inefficiency and cost. The proposed study employs an innovative research methodology, the Multiphase Optimization STrategy (MOST), a framework for developing highly efficacious, efficient, scalable, and cost-effective interventions. The investigators will conduct a randomized experiment to assess the individual components of FN and identify which components and component levels have greatest effect on access to, and engagement in, diagnostic and treatment services for children with mental health disorders. This information then guides assembly of an optimized FN model that achieves the primary outcomes with least resource consumption and participant burden

Detailed Description

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The goal of this study is to determine the optimal delivery of a Family Navigation (FN) model that increases engagement in services to address children's behavioral health. While there is strong evidence that navigation decreases barriers to care for low income and minority families, little is known about which specific components contribute to its efficacy. The investigators propose to use MOST, a pioneering, engineering-inspired framework, to assess the performance of individual intervention components and their interactions.

Delivery of FN will be systematically varied across four components, each of which is represented by a separate factor in the 2x2x2x2 factorial study design. Specifically, each family will be randomly assigned to one of two conditions within each of four factors or delivery strategies, defining sixteen separate experimental conditions. Strategies include: (A) technology-assisted delivery of care coordination using an innovative, web-based platform called Act.MD (compared to usual care); (B) clinic based FN + community-based (compared to clinic-based only); (C) enhanced symptom tracking using more frequent behavioral symptom tracking (compared to standard pediatric surveillance); and (d) individually-tailored visits (compared to a predetermined schedule of contacts). All children will be followed through the electronic health record (EHR) for 12 months, for outcomes in services access and symptom tracking.

The main effects will be estimated of the four experimental factors and their interactions on the study's primary outcome - family engagement in services to address their child's behavioral health. This information then guides assembly of an optimized FN model that achieves the primary outcomes with least resource consumption and participant burden.

Children will be enrolled if they have a positive behavioral health screen OR parent concern. A "watchful waiting" group for families of children with more mild symptoms and/or who do not choose to access child behavioral services at the time of the index visit with the Family Partner (FP) will be included. These families will be followed and child symptoms tracked at 3, 6, 9 and 12 months. If the watchful waiting children have an increase in symptom severity, and/or the family later desires services, they will have the opportunity to receive FN services and be randomized to a study condition.

Conditions

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Health Behavior

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

SINGLE

Investigators

Study Groups

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Group 1- Goat

Clinic-based visit, usual care, standard pediatric surveillance, and structured visits

Group Type EXPERIMENTAL

Usual care

Intervention Type BEHAVIORAL

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Clinic-based visits

Intervention Type BEHAVIORAL

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Standard pediatric surveillance

Intervention Type BEHAVIORAL

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

Structured, schedule-based visits

Intervention Type BEHAVIORAL

Family Partners will utilize a predetermined schedule of contacts with families

Group 2- Cow

Clinic-based visit, usual care, enhanced pediatric surveillance, and structured visits

Group Type EXPERIMENTAL

Usual care

Intervention Type BEHAVIORAL

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Clinic-based visits

Intervention Type BEHAVIORAL

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Structured, schedule-based visits

Intervention Type BEHAVIORAL

Family Partners will utilize a predetermined schedule of contacts with families

Enhanced pediatric surveillance

Intervention Type BEHAVIORAL

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

Group 3- Horse

Clinic-based visit, technology-enhanced care coordination, standard pediatric surveillance, and structured visits

Group Type EXPERIMENTAL

Clinic-based visits

Intervention Type BEHAVIORAL

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Standard pediatric surveillance

Intervention Type BEHAVIORAL

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

Structured, schedule-based visits

Intervention Type BEHAVIORAL

Family Partners will utilize a predetermined schedule of contacts with families

Technology enhanced care coordination

Intervention Type BEHAVIORAL

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

Group 4- Pig

Clinic-based visit, technology-enhanced care coordination, enhanced pediatric surveillance, and structured visits

Group Type EXPERIMENTAL

Clinic-based visits

Intervention Type BEHAVIORAL

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Structured, schedule-based visits

Intervention Type BEHAVIORAL

Family Partners will utilize a predetermined schedule of contacts with families

Enhanced pediatric surveillance

Intervention Type BEHAVIORAL

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

Technology enhanced care coordination

Intervention Type BEHAVIORAL

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

Group 5- Sheep

Clinic-based visit, usual care, standard pediatric surveillance, and individually-tailored visits

Group Type EXPERIMENTAL

Usual care

Intervention Type BEHAVIORAL

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Clinic-based visits

Intervention Type BEHAVIORAL

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Standard pediatric surveillance

Intervention Type BEHAVIORAL

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

:Individually-tailored visits

Intervention Type BEHAVIORAL

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Group 6- Llama

Clinic-based visit, usual care, enhanced pediatric surveillance, and individually-tailored visits

Group Type EXPERIMENTAL

Usual care

Intervention Type BEHAVIORAL

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Clinic-based visits

Intervention Type BEHAVIORAL

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Enhanced pediatric surveillance

Intervention Type BEHAVIORAL

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

:Individually-tailored visits

Intervention Type BEHAVIORAL

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Group 7- Cat

Clinic-based visit, technology-enhanced care coordination, standard pediatric surveillance, and individually-tailored visits

Group Type EXPERIMENTAL

Clinic-based visits

Intervention Type BEHAVIORAL

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Standard pediatric surveillance

Intervention Type BEHAVIORAL

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

Technology enhanced care coordination

Intervention Type BEHAVIORAL

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

:Individually-tailored visits

Intervention Type BEHAVIORAL

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Group 8- Dog

Clinic-based visit, technology-enhanced care coordination, enhanced pediatric surveillance, and individually-tailored visits

Group Type EXPERIMENTAL

Clinic-based visits

Intervention Type BEHAVIORAL

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Enhanced pediatric surveillance

Intervention Type BEHAVIORAL

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

Technology enhanced care coordination

Intervention Type BEHAVIORAL

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

:Individually-tailored visits

Intervention Type BEHAVIORAL

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Group 9- Donkey

Clinic and community visits, usual care coordination, standard pediatric surveillance, and structured visits

Group Type EXPERIMENTAL

Usual care

Intervention Type BEHAVIORAL

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Standard pediatric surveillance

Intervention Type BEHAVIORAL

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

Structured, schedule-based visits

Intervention Type BEHAVIORAL

Family Partners will utilize a predetermined schedule of contacts with families

Clinic-based visits and community visits

Intervention Type BEHAVIORAL

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Group 10- Bear

Clinic and community visits, usual care coordination, enhanced pediatric surveillance, and structured visits

Group Type EXPERIMENTAL

Usual care

Intervention Type BEHAVIORAL

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Structured, schedule-based visits

Intervention Type BEHAVIORAL

Family Partners will utilize a predetermined schedule of contacts with families

Enhanced pediatric surveillance

Intervention Type BEHAVIORAL

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

Clinic-based visits and community visits

Intervention Type BEHAVIORAL

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Group 11- Tiger

Clinic and community visits, technology enhanced care coordination, standard pediatric surveillance, and structured visits

Group Type EXPERIMENTAL

Standard pediatric surveillance

Intervention Type BEHAVIORAL

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

Structured, schedule-based visits

Intervention Type BEHAVIORAL

Family Partners will utilize a predetermined schedule of contacts with families

Technology enhanced care coordination

Intervention Type BEHAVIORAL

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

Clinic-based visits and community visits

Intervention Type BEHAVIORAL

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Group 12- Lion

Clinic and community visits, technology enhanced care coordination, enhanced pediatric surveillance, and structured visits

Group Type EXPERIMENTAL

Structured, schedule-based visits

Intervention Type BEHAVIORAL

Family Partners will utilize a predetermined schedule of contacts with families

Enhanced pediatric surveillance

Intervention Type BEHAVIORAL

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

Technology enhanced care coordination

Intervention Type BEHAVIORAL

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

Clinic-based visits and community visits

Intervention Type BEHAVIORAL

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Group 13- Monkey

Clinic and community visits, usual care coordination, standard pediatric surveillance, and individually-tailored visits

Group Type EXPERIMENTAL

Usual care

Intervention Type BEHAVIORAL

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Standard pediatric surveillance

Intervention Type BEHAVIORAL

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

:Individually-tailored visits

Intervention Type BEHAVIORAL

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Clinic-based visits and community visits

Intervention Type BEHAVIORAL

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Group 14- Zebra

Clinic and community visits, usual care coordination, enhanced pediatric surveillance, and individually-tailored visits

Group Type EXPERIMENTAL

Usual care

Intervention Type BEHAVIORAL

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Enhanced pediatric surveillance

Intervention Type BEHAVIORAL

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

:Individually-tailored visits

Intervention Type BEHAVIORAL

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Clinic-based visits and community visits

Intervention Type BEHAVIORAL

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Group 15- Elephant

Clinic and community visits, technology-enhanced care, standard pediatric surveillance, and individually-tailored visits

Group Type EXPERIMENTAL

Standard pediatric surveillance

Intervention Type BEHAVIORAL

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

Technology enhanced care coordination

Intervention Type BEHAVIORAL

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

:Individually-tailored visits

Intervention Type BEHAVIORAL

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Clinic-based visits and community visits

Intervention Type BEHAVIORAL

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Group 16- Giraffe

Clinic and community visits, technology-enhanced care, enhanced pediatric surveillance, and individually-tailored visits

Group Type EXPERIMENTAL

Enhanced pediatric surveillance

Intervention Type BEHAVIORAL

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

Technology enhanced care coordination

Intervention Type BEHAVIORAL

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

:Individually-tailored visits

Intervention Type BEHAVIORAL

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Clinic-based visits and community visits

Intervention Type BEHAVIORAL

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Interventions

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Usual care

Family partners will keep records and communicate with families using standard information technology, including telephones, electronic medical records, and standard desktop software.

Intervention Type BEHAVIORAL

Clinic-based visits

Family partners will be restricted to working at the primary care clinic - communication will be restricted to telephone, text, and clinic visits

Intervention Type BEHAVIORAL

Standard pediatric surveillance

Monitoring is determined by standard pediatric practice. Behavioral screening is usually done annually.

Intervention Type BEHAVIORAL

Structured, schedule-based visits

Family Partners will utilize a predetermined schedule of contacts with families

Intervention Type BEHAVIORAL

Enhanced pediatric surveillance

In Massachusetts, behavioral screening is mandated at every pediatric visit, which for children in the target population (ages 3-12 years) is annually. With "enhanced monitoring," Family Partners will screen children using validated instruments quarterly and communicate results to the child's care team

Intervention Type BEHAVIORAL

Technology enhanced care coordination

Behavioral: technology enhanced care coordination FPs will also have access to Act.MD, a cloud-based care coordination and communication tool that offers the potential to improve communication with families, schools, and the primary care site through administration of online questions, videoconferencing, and common portals that can be used by parents and multiple providers (e.g., FP, pediatrician, teacher).

Intervention Type BEHAVIORAL

:Individually-tailored visits

Family Partners will be able to meet with families on an as-needed basis, with no predetermined schedule of contacts

Intervention Type BEHAVIORAL

Clinic-based visits and community visits

In clinic-based visits the Family Partner is restricted to working at the primary care clinic and communication is restricted to telephone, text, and clinic visits. However in conditions with clinic based and community visits, the Family Partners will be available to meet families in their home and community (as well as the clinic), and accompany families to community-based meetings at school or childcare.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

All children who are 3-12 years old:

* who screen positive on the Survey of Wellbeing of Young Children (SWYC) (3-5 years) OR
* who screen positive on the Pediatric Symptom Checklist-17 (PSC-17) (6-12 years) OR
* whose parents indicate a behavioral health concern during any pediatric visit

Exclusion Criteria

* Children who are already actively engaged in behavioral health specialty care services, defined as having had a behavioral health visit in the last 30 days, who do not require new additional services
* Children with active psychosis
* Children with safety concerns requiring emergency mental health services.
Minimum Eligible Age

3 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Boston Medical Center

OTHER

Sponsor Role lead

National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Emily Feinberg, ScD, CPNP

Role: PRINCIPAL_INVESTIGATOR

Boston Medical Center and Boston University SPH

Locations

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DotHouse Health

Dorchester, Massachusetts, United States

Site Status

Countries

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United States

References

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Broder-Fingert S, Kuhn J, Sheldrick RC, Chu A, Fortuna L, Jordan M, Rubin D, Feinberg E. Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol. Trials. 2019 Dec 16;20(1):728. doi: 10.1186/s13063-019-3853-y.

Reference Type DERIVED
PMID: 31842963 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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1R01MH117123-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

H-37634

Identifier Type: -

Identifier Source: org_study_id

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