NEW YORK, NEW YORK July 12, 2018—An early childhood initiative that partnered 11 New York City health systems with one or more community-based organizations each screened 5,534 very young children and their caregivers in New York City over the past year for socioeconomic factors that can affect a child's health, and found that more than a third (1,890) needed services that addressed social or developmental needs.
The teams reported that adult education and child care were the two most common social needs, with food insecurity a close third. A high percentage of families at several practices were found to have one or more social needs, among them poor housing, maternal depression, exposure to violence, and child behavioral concerns. All these factors, often referred to as social determinants of health, can adversely affect the physical development of very young children, causing lifelong health and educational challenges.
The Partnerships for Early Childhood Development initiative, jointly funded by United Hospital Fund, the Altman Foundation, and The New York Community Trust, was established in March 2017 to develop and support clinical/community organization partnerships that could screen children and their families for social determinants of health and refer them to services. UHF took the lead on the project's management and produced a report, Clinical-Community Partnerships for Better Health: Observations from New York City's Partnerships for Early Childhood Development Initiative, analyzing the results of Phase I of the project, ending in March 2018. Phase II of the project, with eight of the original teams participating and continued support from UHF, Altman, and The Trust, will begin in August.
“The experiences and observations of the PECD participants provide lessons not only for pediatric practices seeking to develop community partnerships but also for health care providers serving other at-risk populations,” said Anthony Shih, MD, MPH, president of UHF. “This report presents a valuable model approach for addressing critical non-clinical aspects of child health and for the larger possibilities for clinical-community partnerships.”
The medical community has increasingly realized in recent years the importance and prevalence of social determinants of health. Almost half of all families in the United States are either living in poverty or dealing with financial distress, unable to cover basic needs such as food, housing, health care, and child care. In 2016 the American Academy of Pediatrics recommended that children be screened for social determinants of health, and called on pediatric practices to connect patients and their caregivers with community organizations that can help them get the services and resources they need.
“Screening for social needs is challenging, and acting on such needs can be even harder,” said report co-author Suzanne Brundage, director of UHF's Children's Health Initiative, Patricia S. Levinson Fellow at UHF, and head of PECD. “The first year of the PECD initiative has yielded valuable information for building meaningful clinical-community partnerships that will be helpful to others seeking to establish these kinds of partnerships.”
The analysis found that most of the clinical practices referred 50 percent or more of those families with social needs for community services, but rates of service use were much lower. The teams reported challenges in tracking whether families connected with community services, and in some cases family reluctance to be screened or act on a referral because of a lack of trust, fear of involvement by child protective services, or concerns related to immigration issues. To get families to complete screens and referrals at a higher rate, teams were trained on immigrants' rights and culturally sensitive approaches to screening.
The participating PECD teams also dealt with their own workflow inefficiencies and information technology limitations. Most relied on paper screens and referrals, since compatible electronic health records and tablets were often not available to both sides of the partnerships. Teams also struggled with tracking referrals electronically and sharing information.
Some health systems also found it challenging to get buy-in from their clinicians, but found that rotating medical residents through their community partners' sites increased enthusiasm for the program. Sharing stories of families whose needs were addressed through the referrals also helped. “We learned that building strong clinical and community organization partnerships requires effort on both sides,” said Matlin Gilman, UHF health policy analyst and co-author of the report.
Phase II of PECD will build on the progress made in the first year, and focus on streamlining teams' workflows, expanding screening programs, and improving processes for connecting families to services and getting feedback.
The health systems participating in the first year of the initiative were BronxCare Health System; Cohen Children's Medical Center (part of Northwell Health); NYC Health + Hospitals/Coney Island; NYC Health + Hospitals/Gotham Health, Gouverneur; Interfaith Medical Center; Montefiore Medical Center; The Mount Sinai Hospital; NewYork-Presbyterian/Columbia University Irving Medical Center; NewYork-Presbyterian Queens; NYU School of Medicine/Family Health Centers at NYU Langone; and St. John's Episcopal Hospital.
The full report can be downloaded from UHF's website here.
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