A promising United Hospital Fund initiative targeting social and environmental risks to young children's health is beginning a second phase, with a new round of support from the project's original funders—UHF, the Altman Foundation, and The New York Community Trust.
The Partnerships for Early Childhood Development, launched in March 2017, forged links between pediatric practices at 11 hospitals and 17 community organizations, with the goal of addressing psychosocial risks to children from infancy to age five, the formative period shaping lifelong health and functioning.
Participating practices screened families of young patients for one or more risks—such as food insecurity, unsafe housing, or parental depression—and then connected families to social service organizations for help. The three funders provided a collective $703,062 in support, for direct grants to the clinical-community teams and for a UHF-led learning collaborative that brought participants together to share best practices.
In this new phase, the funding collaborative will provide $709,122 for grants to eight of the original participating hospitals and community partners to fine-tune and expand their work, and to continue the learning sessions.
A new UHF report, Clinical-Community Partnerships for Better Health, reviews the progress and challenges of the project's first year, during which teams screened 5,534 families. Some findings were unexpected.
“A number of pediatricians told us that they experienced real ‘aha!' moments when they looked at the data from the screening surveys and learned what families reported were their biggest struggles and crises,” says Suzanne Brundage, director of UHF's Children's Health Initiative and Patricia S. Levinson Fellow. “Lack of access to adult education and lack of quality child care were both more prevalent than expected—and more common than most other needs, including food support, housing support, and maternal depression.”
Building thriving clinical-community partnerships was another accomplishment. Some of the practices had significant screening experience and procedures in place when the initiative started, while others were just learning to screen for risks, but every team made progress and was committed to strengthening relationships and developing new models of care.
Some of the partnerships are evolving in interesting ways. NewYork-Presbyterian/Columbia University Irving Medical Center has begun screening for social needs in three additional pediatric clinics. Northwell Health is introducing the screening process pioneered at Cohen Children's Medical Center to all its internal medicine practices. In addition, medical residents are now doing formal rotations at two locations of its community partner.
“In the project's first year, all teams demonstrated that they could build new systems for identifying families at risk and referring them to trusted partners for needed services,” says Ms. Brundage. “This phase is all about making sure those new systems truly work, that families systematically get to the services they need and that that information is successfully communicated back to providers.”
CLOSING THE LOOP
Strengthening procedures for connecting families to services—and strengthening the partnerships to ensure that the feedback loop is seamlessly working—are top goals for the project's new phase. While 1,890 of the screened families reported having at least one psychosocial need, teams made 634 referrals to community partners, and documented the cases of 395 families receiving services from those partners—a differential that likely reflects both family reluctance to seek services and an inability to adequately track those who do.
Creating new strategies for workflow, communications, and staff training to help close such gaps is the focus of all eight teams. But the success of their efforts to improve the trajectory of children's lives will have broader implications as well.
“This initiative is one of the first fruits of UHF's prioritization of clinical-community partnerships as a cornerstone of a high-quality health system—and improved health—for all,” says UHF President Anthony Shih, MD, MPH. “It's providing valuable lessons not only for pediatric practices but also for health care providers serving other at-risk populations.”