After a year of innovative collaborations to address the outsize impact of social and economic forces on children's life-long health, UHF's groundbreaking Partnerships for Early Childhood Development (PECD) project has shown the promise of clinical-community partnerships, and uncovered some overriding priorities.
PECD aims to help pediatric primary care practices screen all children up to age 5, and their families, for social determinants of health such as unsafe housing, inadequate nutrition, and exposure to violence, and create effective referrals to address them. Practices from 11 health systems joined with one or more of 18 community organizations, with grant support from UHF, the Altman Foundation, and the New York Community Trust. UHF took the lead on project management and program development, including a critical learning collaborative.
The teams screened nearly 4,000 patients and made 730 referrals; multiple sites reported that more than half of all screenings uncovered at least one psychosocial need. One unexpected insight: “Nearly all the teams were surprised by the extent to which families said they needed quality child care and adult education,” said Lee Partridge, an advisor to the project.
But child care and education were among the most difficult resources to secure, due to limited capacity and complicated enrollment processes. “As a pediatrician I see food insecurity and that's the issue that creates the most panic in the bottom of my stomach, but sometimes that's not the parent's priority” said one participant. “I had a mother who screened positive for every single thing on the six-item screener and really what she needed was child care. Once she had that she could get her GED or get a job or do other things that would solve the food insecurity problem.”
Although some parents were initially wary about answering the project's questionnaires, practitioners found that asking families about their lives could lead to more productive conversations. A far larger hurdle was the inability to efficiently document the outcome of those conversations. “The lack of compatibility between systems, and the inability to record and track the results of screenings, made the workflow between partners incredibly complex,” said Suzanne Brundage, director of UHF's Children's Health Initiative, and UHF's Patricia S. Levinson Fellow.
Nevertheless, participants were overwhelmingly enthusiastic about the possibilities PECD raised, and the opportunities that the learning collaborative provided. Many participants stayed to talk and share experiences long after each session officially ended, Ms. Brundage said.
Eight of the partnerships will continue, with additional funding and technical assistance. “Pediatricians and social service providers really want to work together,” said Ms. Brundage. “It doesn't take a lot of investment to encourage these types of relations. They just need a push.”