Out of the Clinic and Into the Community: The UVA Pediatric Home Visit Program

December 3, 2020 by

By Amy Brown, MD, MHS, Division of General Pediatrics, Pediatric Home Visit Program Director

UVA residents work with a patient at a home visit.

A special home visit day for a very special patient

The Program

The UVA Pediatric Home Visit Program began in 1995 under the direction of Dr. Leigh Grossman. She founded the program on the belief that as the practice of medicine has developed, we have gotten farther away from knowing our patients. Physicians used to know their patient’s community, the neighborhoods and even the households within those neighborhoods.

The UVA Pediatric Home Visit Program focuses on the art of making house calls and is a required part of the curriculum for every pediatric resident. While each resident has the opportunity to participate in home visits once a year, many go multiple times and may become resident leaders. As a leader, they are in charge of all visits that day. They help recruit patients, review referrals from nurses, attendings, and word of mouth, make calls to schedule visits, and oversee the other residents on the home visit that day. As the current director of this program, I believe you cannot practice pediatrics without understanding where your patients come from and how often social determinants create barriers to health and healing.

Visits and Patients

Every month is an adventure! We see patients that consider the Birdsong clinic their medical home. Most visits are well-child checks. We also do follow-ups for chronic conditions. For example, if a patient is seen in the ER for asthma, we may go to their home a few days later to see how their breathing has improved. We also see children with ADHD, anxiety, and depression.

We go out once a month – our visits take all day and we see several families. We have traveled all over Charlottesville, Albemarle County, and the 7 surrounding counties. We have been to very rural areas – one visit was to a farm with 17,000 chickens to see a 17-year-old patient with chronic disabilities. It was difficult for her parents to travel to UVA for her checkups and the ability to see this patient in her home was a tremendous help to her family. There are also marginalized families incredibly close to UVA. A patient that lives within a few miles of the hospital might have to take 3 different bus lines just to get to their well-child check. Therefore, patients are typically quite grateful for this service.

At the start of COVID, we had to suspend the program from March to July. Thankfully, we were able to re-start home visits in August, and families welcomed us back into their homes. It has really been a joy to be back and to continue to care for these kids.

Three UVA residents ready for a home visit to patients.

Some of our wonderful residents getting ready for their next visit

The Impact on Residents

With home visits, the residents see firsthand that not everyone grew up the way they did. Often we see patients that feel disenfranchised from UVA as their medical home. Sitting in the living room with a family and talking with them face to face allows us to reconnect with them again and to show them that there are physicians who care about their children and want to provide the best care possible for them. We want them to know UVA can support them and get them back on their feet as they care for their children.

Through this program, we realize that getting residents outside of their comfort zone and their familiar clinical environment has a profound impact on the physicians they become. A patient’s home is an environment you can’t control and it teaches you how to adapt. If a resident sees there is no baby gate on the staircase, they must determine how to address the concern in a socially appropriate way. We often need to address safety concerns with a family who may not know where their next meal will come from, which changes the conversation entirely. To watch the residents “get it” is something truly special.

After home visits, I ask the residents to write reflections on their experience. Here are a few excerpts from their writing:

“It is important as physicians to be able to empathize with our patient population and understand the limitations that may limit their access and ability to comply with our recommendations. The home visit program provides us with insight into the realities and hardships that our patients and their families face.”

“Seeing a family in their home adds so much depth to your understanding of their unique family dynamic, relationship with the community, and barriers to care. It seemed like both parents and patients were more open and relaxed in their own homes, and were more willing to offer their stories, struggles, and concerns.”

“I’m grateful for having had the opportunity to go on home visits. Since we only see patients in the clinic or inpatient setting, it can be hard to imagine what life is actually like for our families outside of their appointments.”

“We visited one family that kept the lights and the AC off in the middle of summer which was likely a way for them to save money. It’s something that we take for granted and don’t always realize that others don’t have the same resources until experiencing it firsthand.”

“I think the best part about home visits was interacting with patients in a more casual manner. It seemed like the patients opened up more because they weren’t in a sterile, unknown location. They played with their games and wanted to show us their toys. It was nice being involved in their lives and being welcomed into their homes. They were grateful we were there and we were grateful for being able to visit.”

“For the first time, I went out of the “Charlottesville Bubble” into the Real Charlottesville. We visited a community of trailer homes where many of our patients live. It opened my eyes to a community that I never knew existed here.”

“By experiencing our patients’ social determinants of health firsthand, we gain invaluable insights into our patients’ lives and the challenges they face.  I am so appreciative that home visits were a part of my residency training.”

“I am so glad UVA has such a unique program that gives us a glimpse into the patients’ lives. What a better way to understand the ‘well child’ than to visit the environment that molds that child? We think as physicians we get a complete look into our patients’ lives in that 20-30 min clinic encounter with the artificial environment that the children associate with getting shots and blood draws.” 

UVA residents with a family outside with masks on for COVID.

Just an average outdoor home visit in the era of COVID

A Personal Note

I moved to Charlottesville in 2008 to complete my pediatric residency training. I knew the downtown mall, wineries, and many of the other beautiful places here. However, it was not until I became a resident leader for the home visit program that I was exposed to many underserved neighborhoods that I never would have known about otherwise, which have since become special to me. Charlottesville is a wonderfully diverse community that needs our support.

I believe it is so important to be aware of the real issues that people are facing and there is no better way than to go and see it firsthand. This program has allowed me to better care for patients in a hospital setting because I have a better understanding of the needs and lack of resources these families are facing.

I guess it is my background in public health and as the Pediatric Global Health Leadership Director that leads me to believe that meeting people where they are at is so incredibly important for us, both individually and as a society.

Last Thoughts

Programs like the Pediatric Home Visit Program are the face of UVA pediatrics to the community! From an education standpoint, getting into the community is vital. Insurance companies are already starting to reimburse for home visits because they understand the incredible value these visits have for the health of our patients. In the future, there will likely be many more models like this one.

Please reach out to me if you know a patient that would benefit from a home visit. We are happy to help.

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