Funded Projects

Mobile Clinics Expanding Pediatric Neurodevelopmental Care

Project Year

2024

City & State

Houston, Texas

Program Name

CATCH Resident

Topic

Access/Barriers to Health Care (LHI)

Program Description

The Problem:   Access to pediatric healthcare in the greater Houston area, especially neurology and neurodevelopmental services, faces significant challenges such as transportation issues, language barriers, mixed immigrant status, limited healthcare system knowledge, and extended wait times for specialized care. These factors contribute to delays in diagnoses and treatment, resulting in a decreased quality of life for affected children. Despite the existence of Child Neurology (CN) and Neurodevelopmental Disabilities (NDD) programs at multiple sites within Texas Children's Hospital (TCH), many children encounter unrecognized and untreated conditions due to barriers in accessing care.   Primary Setting:   Texas Children’s Hospital (TCH) operates CN and NDD programs at five sites in Houston, where NDD fellows often encounter patients with untreated seizures and developmental disabilities. The lack of NDD diagnoses and treatment is attributed to the high volume of new immigrants arriving yearly and the numerous barriers patients face. While TCH has established mobile units to provide general pediatric care to underserved Houston children, these units lack specialized care, creating a gap in addressing neurodevelopmental needs within the community.   Children Affected:   Children in underserved communities face a higher burden of neurologic and neurodevelopmental diseases, with a prevalence of 1 in 26 for seizures/epilepsy and 1 in 6 for developmental delays per national data. Social and emotional variables, coupled with limited access to high-quality foods, contribute to poor nutrition, adversely affecting brain development and increasing the risk for neurodevelopmental disorders. Immigrants, children in poverty, and communities with higher rates of violence are at a heightened risk for trauma, associated with increased neurodevelopmental disorders.   Proposed Intervention:   Recognizing the gap in current healthcare models, the proposed intervention aims to integrate CN/NDD visits into TCH mobile units, offering a monthly clinic with dedicated fellows. While existing literature supports the role of mobile health clinics in delivering healthcare to underserved communities, specific services in neurology or developmental-behavioral pediatrics are lacking. This intervention seeks to address identified barriers and provide comprehensive neurodevelopmental evaluations to children in underserved communities, bridging the existing gap in specialized care.   Project Goal:   The overarching goal of the project is to significantly improve neurodevelopmental health outcomes for children in underserved Houston communities by seamlessly incorporating CN/NDD assessments into TCH Mobile Units by June 2025. The aim is to reduce access barriers and advance equitable health service provision, ensuring that children receive timely and appropriate care.   Anticipated outcomes:   Anticipated outcomes include conducting surveys with at least 50 families and all mobile unit medical providers to obtain a detailed report summarizing neurodevelopmental concerns. Historical comparisons with referral data for similar conditions will provide insights into the evolving needs of the community. The project also aims to identify primary barriers to neurodevelopmental care by analyzing social determinants of health (SDOH) screening responses from at least 50 families seen by TCH mobile units, informing the development of barrier-mitigation strategies. The ultimate objective is to successfully implement a monthly clinic within TCH mobile units, providing neurodevelopmental evaluations by CN/NDD fellows and reaching at least 80% of identified patient referrals, ensuring a significant positive impact on the community's access to specialized care.    In summary, this project not only identifies and addresses barriers to neurodevelopmental care but also proposes a tangible solution through the integration of mobile health clinics, ultimately improving the lives of children in underserved communities in Houston. 

Project Goal

To significantly improve neurodevelopmental health outcomes for children in underserved Houston communities by seamlessly incorporating comprehensive Child Neurology (CN) and Neurodevelopmental Disabilities (NDD) assessments into the existing Texas Children’s Hospital (TCH) Mobile Units' framework by June 2025, thereby reducing the current access barriers and advancing towards equitable health service provision. 

Project Objective 1

Objective #1: By October 2024, conduct surveys with at least 50 families and all mobile unit medical providers to evaluate the demand and specific needs for neurodevelopmental evaluations within the TCH mobile units. 

Project Objective 2

Objective #2. By October 2024, identify the primary barriers to neurodevelopmental care by analyzing social determinants of health (SDOH) screening responses from at least 50 families seen by TCH mobile units and compare these findings with those documented at the TCH Blue Bird Neurology Clinic. 

Project Objective 3

Objective #3. By June 2025, successfully implement a monthly clinic within the TCH mobile units that provides neurodevelopmental evaluations by CN/NDD fellows, reaching at least 80% of the identified patient referrals. 

AAP District

District VII

Institutional Name

Texas Childrens Hospital

Contact 1

Mariana Carretero Murillo, MD