The Theresa Lang Center is located in Flushing in Queens County and serves several New York City neighborhoods with high health disparities, including Corona, Elmhurst, and Jackson Heights. The population is culturally and ethnically diverse, a mixture of older and more recent immigrants, many of modest income and whose English proficiency is limited. The clinic offers a full range of general and specialty pediatric care. It is also a major training site for the Weill-Cornell Medical School, with some 60 residents rotating through the clinic each year. It is affiliated with NewYork-Presbyterian Hospital/Queens.
Theresa Lang: Key Elements
Type of practice
- High-volume pediatric clinic providing full range of general and specialty pediatric care, seeing more than 5,000 children under age 5 per year
- Training site for Weill-Cornell pediatric residents
- Flushing, Queens County, New York City, a culturally and ethnically very diverse community
- 75% to 80% of patients are insured by Medicaid
- Approximately 40% of the families have limited English proficiency
- Develop a close partnership with a community organization that offers significant support services for new mothers and their infants
- Use health information technology to streamline the screening and referral processes
- Conduct family satisfaction surveys to inform and refine process and experience
In late 2016, as the leadership of the Center considered incorporating psychosocial needs screening into its practice, it decided to work in tandem with a community partner and to focus on meeting the needs of new mothers and children under age one. They entered into an agreement with Public Health Solutions (PHS), a large health and social services organization that has a major presence in Queens and operates a nurse-family partnership program, parenting classes, and other support services. The Center and PHS staff collaborated on the family needs survey design, ultimately choosing a combination that addressed maternal depression, food insecurity, caregiver support, breastfeeding, literacy and education, and immigration/legal issues.
The new screening and referral process began in 2017, with screenings done at 1-month, 2-month, 4-month, and 6-month well-child visits. (During the initial period some patients objected to the frequency of the screening. The Center then reduced the frequency to three screenings: at the newborn, 1-month, and 4- month visits.) Parents completed the paper-based screen in the waiting room and the results were entered in the medical record by Center staff. Families who identified needs were referred to PHS, whose community health workers then reached out to schedule appointments. PHS sent monthly reports to the Center on the status of each referral.
After some months of operation, the Center staff decided this system was not ideal. Survey responses had to be entered into the medical record manually, and referrals to PHS had to be sent by fax. Both processes were cumbersome and time-consuming, so the Center contracted with Phreesia, a technology company, to design an electronic screening tool that would be more efficient for the Center, for families, and for PHS. The new system uses both a tablet and a mobile app for the surveys, allowing parents to complete at home or in the office, and responses are transferred electronically to the medical record. Information necessary for referrals can be shared with PHS electronically. This updated system has been in place since 2018 and is working well for all parties involved—the Center, PHS, and families. This system has also been implemented at another NewYork-Presbyterian/Queens pediatric clinic in Jackson Heights, also in partnership with PHS.
The Center staff has conducted some informal satisfaction surveys with parents about the screening process and, if referred to PHS, whether that organization had been helpful. The parent responses were very positive. The Center plans to expand its use of such satisfaction surveys to further refine the process. Relatedly, PHS is developing a methodology that captures and sends back to the Center more detail on the outcome of each referral.
“This [partnership] project”, says Center project director Dr. Rachel Sharret, “has allowed our medical institution to better learn about the needs of our community and the resources available to our families. It has helped our providers feel a rededication to the importance of these needs in our families’ overall health.” Both partners envision a long-lasting relationship.