311 - Factors Influencing Caregiver Engagement in Pediatric Care Management: Insights from North Carolina Integrated Care for Kids

Publication Number: 311.4633

Hartlee Lidsky, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Eleanor Wertman, UNC Health Alliance, Durham, NC, United States; Hadiya Sadiq, Gillings School of Public Health, Lancaster, SC, United States; Greeshma James, Westat, Indianapolis, IN, United States; Kori Flower, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Chelsea A. Swanson, Duke Margolis Institute for Health Policy, Durham, NC, United States; Anna J. Hatley, Duke University School of Medicine, Winston Salem, NC, United States; Michael J. Steiner, UNC School of Medicine, chapel hill, NC, United States; Rushina Cholera, Duke University School of Medicine, Durham, NC, United States

Background: Pediatric care management can address health-related social needs (HRSNs), but engaging and retaining families is challenging. North Carolina Integrated Care for Kids (NC InCK) is a model funded by the Centers for Medicare and Medicaid Services that uses multisector data to identify Medicaid-insured children in five counties who may benefit from longitudinal care management to access HRSN supports. We aimed to describe engagement and explore engagement drivers in NC InCK care management.

Objective: To 1) report engagement rates and 2) identify barriers and facilitators to enrollment and retention in NC InCK care management.

Design/Methods: This mixed-methods study documented care management engagement rates and qualitatively explored engagement drivers. Program engagement rates were calculated using NC InCK eligibility and enrollment data. English-speaking caregivers of NC InCK-eligible Medicaid-insured children were randomly selected from two cohorts with different engagement patterns, either brief or persistent. Cohort-specific guides for qualitative semi-structured interviews were developed using a conceptual model. Rapid qualitative analysis was used to summarize transcripts, and summaries were organized into a respondent/domain matrix for thematic analysis.

Results: Fifty-nine percent of eligible caregivers were unreachable or declined services, 16% briefly engaged but were lost to follow-up, and 25% persistently engaged (Figure). Interviews were conducted from Apr to Oct 2024 with 18 briefly engaged and 16 persistently engaged caregivers of eligible children ages 2-20. Both cohorts desired connection to beneficial services, but lack of familiarity with the care manager's role and prior experiences with unreliable or punitive social systems were barriers to enrollment. Care managers who were kind, timely, consistent, and nonjudgmental promoted both enrollment and retention. Family crises often led to disengagement at times of high need, while flexible communication maintained connections. Caregivers noted that care managers improved entire family well-being and addressed HRSNs like food or stable housing; however, a constrained resource landscape hindered their ability to meet all needs.

Conclusion(s): Caregivers report that NC InCK care management offers crucial support for HRSNs, but most eligible families are not engaged due to external challenges like past negative experiences, limited resource availability, and family crises. Improving engagement may require proactive education on care manager roles, crisis-responsive follow-up, and strategic resource partnerships.

North Carolina Integrated Care for Kids (NC InCK) enrollment workflow
Most families eligible for NC InCK care management never engage with services or are lost to follow up (data from model implementation through June 2024).

North Carolina Integrated Care for Kids (NC InCK) enrollment workflow
Most families eligible for NC InCK care management never engage with services or are lost to follow up (data from model implementation through June 2024).