Academic journal article The Future of Children

HealthySteps: Transforming the Promise of Pediatric Care

Academic journal article The Future of Children

HealthySteps: Transforming the Promise of Pediatric Care

Article excerpt

How might we, as a society, help parents and caregivers develop the secure, loving relationships with their babies and toddlers that foster healthy development and resilience? And how might we also help families who are facing adversity connect to community supports so they can protect their children from repeated, toxic exposures that can harm development? Whatever their social or economic circumstances, most new parents feel enormous societal pressure to be "perfect" at parenting, so the setting for such interventions would need to be trustworthy and nonstigmatizing. Parents must want to participate, and not be labeled or judged for doing so. The ideal setting would also be universal--a place where all parents and children already go, without facing significant cost, long wait times, or great distances. Finally, it would give families ongoing access to a range of professionals trained to assess and help with child and parent challenges that can impact a child's development.

This ideal setting already exists: pediatric primary care. Pediatric care (including, as defined in this article, primary care provided to young children by family practitioners and nurse practitioners in other settings) is among the least stigmatizing and most universally accessed services in the United States. (1) According to 2016 national data. 89 percent of children five years old and younger had experienced a preventive visit in the past year. (2) (Compare that, for example, to the 7 percent of eligible children under three who access the federal Early Head Start program. (3)) In addition, given that the recommended schedule includes 13 well-child visits in the first three years of life, pediatric care provides an opportunity to interact with families repeatedly. Researchers studying the intergenerational transmission of risk from mother to infant note that primary health care providers play a "pivotal role in facilitating access to support services" that can break vicious cycles of adversity. (4) The leading professional association, the American Academy of Pediatrics (AAP), has recognized this promise; it urges pediatricians to address adverse childhood experiences and the effects of poverty on children. (5) Pressure is also mounting throughout pediatrics to integrate professionals from different disciplines into a coordinated office team to help families cope with any challenges they face, whether social, emotional, behavioral, financial, physical, or environmental. (6) But before pediatrics can fulfill this promise nationally, it must overcome several obstacles.

In this article we examine some of these obstacles, and we highlight a leading model of family-centered, relationship-based care, called HealthySteps, that transforms how pediatric and family practices support families with young children. By expanding the array of needs addressed in pediatric care. HealthySteps offers a sustainable model of relationship- and team-based primary care that has demonstrated positive impacts for children and their families.

Challenges in Pediatrics

For years the AAP has recommended that pediatricians routinely use validated screening tools to identify risks to development in every child as effectively and as early as possible. Despite this recommendation. US screening rates remain consistently low. Only 30 percent of parents responding to a national survey reported having completed a developmental screening tool when their child was between nine and 35 months of age. (7) Surprisingly, that number rises to only 37 percent for children whose primary care meets the AAP's definition of a "medical home," defined as care that's accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. (8)

Even when pediatric practices screen for risks, families can't necessarily access important resources and services. Among families who need help arranging or coordinating their children's care among different doctors or services, only 16 percent say they receive that support. …

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