With NICH, Care Extends Beyond the Hospital Doors
Oakland Mother Zaina Carney’s biggest problem wasn’t the sickle cell anemia that her two-year-old daughter was diagnosed with at birth. Her biggest obstacle was navigating a complex and fragmented health system to find adequate and consistent support for her child.
To help Carney set her daughter on a healthy path, the family was enrolled into UC San Francisco's Novel Interventions in Children’s Healthcare (NICH) program and assigned a dedicated interventionist who provides around-the-clock therapeutic support in all aspects of their lives. Interventionists are like life coaches but help families overcome obstacles to health both inside and beyond the hospital.
NICH was originally developed at Oregon Health & Sciences University to help youth who experience complex medical conditions alongside psychosocial barriers to care known to drive poor health outcomes, such as housing, food, or transportation insecurities. These children face hardships that cannot be addressed within a hospital, and despite efforts with preexisting resources they often suffer through frequent illness and emergency room trips.
A team led by the UCSF Division of Pediatric Endocrinology brought the NICH program to UCSF in 2020 and has shown (in abstracts presented at the 2022 and 2023 American Diabetes Association Scientific Sessions) that participating youth with diabetes improved management of their diabetes and had fewer depressive symptoms after one year in the program. Meanwhile, their caretakers experienced less diabetes-related distress.
The team is now focused on extending the program to those with other medical conditions and expanding capacity to increase access to the life-changing help that NICH provides.
Support from the Hospital, Beyond the Hospital
Through weekly in-person visits, daily contact over the phone, and uncompromising availability, NICH interventionists are assigned to no more than eight patients at a time and typically spend a year with each family. This low caseload allows them the time to establish a strong, trusting relationship and be available when other healthcare services are difficult to reach, whether on short notice or in the middle of the night.
“What I appreciate most is that [my interventionist] has my back through everything,” says Carney. “Doctor visits with her at my side are so much less stressful than when I’m there by myself with my two young kids.”
For the more than 75 patients enrolled in the program in the first three years, interventionists have assisted parents with job applications, supported efforts to reunify children in foster care with their parents, developed and monitored daily medication routines, implemented use of at-home medical technology, and even supported a family’s move after their home burned down.
By assisting with non-medical issues that affect health, interventionists effectively extend the reach of healthcare services to help children and families address the range of challenges they face.
Growing the Program to Reach More Children
Mitigating negative effects from such issues is critical for successful management of their medical conditions. For the children enrolled in NICH with chronic medical conditions like Carney’s two-year-old, this means fewer hospitalizations, improved health, and a happier life.
Each additional interventionist means up to 8 children each year are supported in their journey toward sustained health, bolstering the healthcare system through reduced emergency room visits and stress on care providers.
To help the NICH program expand capacity to serve more children and families who could greatly benefit from an interventionist, UCSF’s team has received upwards of $2 million in grants and contracts in 2023, including nearly $1 million from the California Department of Health Care Services.
For Carney, NICH aims to empower her with the knowledge, skills, and environment needed to give her daughter the best chance of a healthy life. “I learned from my interventionist to be more accepting of new things. With her support, my daughter and I are finally receiving the help and information we’ve needed,” says Carney.