Adaptations of an evidence-based intervention for child obesity treatment delivered in a home health setting: a brief report.

Abstract

Background: Access remains a key barrier preventing families from enrolling in intensive health behavior and lifestyle treatment (IHBLT) to manage their obesity.

Purpose: This demonstration project integrated the Positive Actions Towards Health (PATH) IHBLT into a home health agency, documented delivery adaptations, and explored preliminary effects on health outcomes.

Methods: PATH was embedded into home health workflows and billed to Medicaid. Clinicians at a pediatric clinic referred patients ages 6-12 years with obesity (body mass index percentile [BMI%ile] ≥ 95th) to the home health agency who then delivered the 12-month program in the child's home as part of their standard practice. The Framework for Reporting Adaptation and Modifications to Evidence-based Interventions (FRAME) was used to document modifications and Reach Effectiveness Adoption Implementation and Maintenance was used to track implementation. BMI%ile, blood pressure, and quality of life (QoL) were tracked.

Results: Eleven adaptations were identified using FRAME-IS. Key modifications to improve delivery included building PATH lesson content and assessment into the home health EHR, digitizing a tailored weight path to inform program adherence, and refining recruitment procedures. Ten families enrolled, attending an average 8 ± 7 sessions (Mean ± SD; range: 2-21). Five participants completed measures at six months and two at twelve months. Across timepoints BMI%ile appeared to be attenuated, systolic blood pressure improved, and gains in QoL were evident.

Conclusions: The PATH IHBLT was adapted for home health delivery and billed to Medicaid, showing preliminary success but challenges with retention. Further work is needed to increase dosage of IHBLT delivered in the home setting.