Children and families require a health care system that serves their unique needs and supports life-long health and well-being. Knowing that the nation’s pediatric medical system fails so many children, particularly from Black, Indigenous, and Latino communities, it is imperative to rethink how children and families receive care. During a recent discussion with the Center for Health Care Strategies (CHCS) on the urgent need for racial justice in the pediatric health care system, Ben Danielson, MD, a pediatrician and advocate for improving outcomes for all kids, noted: “We need to redesign the spaces and places where we go, where we live, where we play, where we find joy, and where we work every day. And we are the ones to do it.” We — including every one of us, whether we are policymakers, pediatricians, public and private payers, philanthropic funders, community health workers, advocates, or families — all have a role to play in reimagining how we care for children and provide opportunities for them to thrive.
A Reimagined Health Care System
To fully support the goals of health and well-being for children, a reimagined health care system should be intentionally anti-racist, seek to meaningfully partner with children and families, and honor each family’s unique strengths and challenges, all with the goal of supporting health and well-being. Unfortunately, in most instances child health care providers do not have the time, resources, or tools to make these changes, particularly now as they navigate vaccine rollout and a surge in demand for COVID-19 testing. This, in combination with the racism ingrained in our country’s health care system, results in poor health outcomes for children in marginalized communities.
Fortunately, there are experts across the child health care field who are committed to identifying, testing, and implementing strategies to transform how care is practiced. These experts recognize that health is impacted by so much more than the small amount of time a child typically spends in a doctor’s office. Expanding the focus of pediatric care beyond medical care can provide significant benefits for health and well-being.
Following are strategies that are integral to supporting a more upstream, preventive, and holistic pediatric delivery system that treats all young patients and their families with dignity. These strategies were developed through Accelerating Child Health Care Transformation (ACHT), a national initiative led by CHCS with support from the Robert Wood Johnson Foundation, that is seeking to uncover opportunities for improving children’s health care.
1. Adopt Anti-Racist Practices and Policies to Advance Health Equity.
Racism, a driver of health inequities, is experienced in the health care system by patients, caregivers, and providers alike and is reinforced by policies, practices, and interpersonal relationships. Child health care providers can work to dismantle racism in the field through explicit efforts, such as establishing anti-racist policies and practices that disrupt systemic racism and promote equity and dignity for patients and their families, as well as for staff. For example, a pediatric practice leader may work with staff to promote a trauma-informed environment rooted in mutual trust and dignity by validating feelings that families of color express about their health care treatment; ensuring that interventions are responsive to families’ unique needs; and considering beliefs and cultural backgrounds in planning and delivery of care.
2. Co-Create Equitable Partnerships Between Families and Providers.
Families are a powerful force for sustaining child health and lifelong well-being. Valuing a family’s autonomy and expertise about their child creates an opportunity to gain their confidence and establish a trusted partnership. Children have a better chance of receiving the care they need when their caregivers feel comfortable asking questions of their child’s health care providers, providing context to inform the care plan, and openly sharing areas of struggle or need. Some practices may invite family members to participate on their board to co-design family engagement opportunities, which can result in families feeling confident that their opinions and values are respected.
3. Identify Family Strengths and Health-Related Social Needs to Promote Resilience.
Every family possesses a unique set of strengths and needs. The pediatric care team can help families identify and explore their strengths as well as their health-related social needs as part of an assessment done during routine visits. By using tools such as co-creation of ecomaps with families, the pediatric care team can gain a better understanding of the family’s priorities and, in turn, help connect families to any necessary resources and referrals. Encouraging a child or their family to define their own needs alongside the clinical expertise of the pediatric care team promotes resilience and allows a family to inform their care in ways that are equitable, which encourages positive health, developmental, and educational outcomes.
Bringing Pediatric Practice Change to Scale
Innovative financing structures and accountability measures are needed to address the lack of time, resources, and tools that pediatric care teams have for committing to a reimagined child health care system. Accountability measures need to be patient-centered, focus on the specific developmental needs of children, and gauge progress in addressing racial and ethnic health disparities to better support child and family well-being. Financing structures must encourage more intentional investment in optimal child development and upstream prevention. Though time intensive, some have successfully co-developed tools with families that measure things that families prioritize, such as family’s unique goals for their care or developmental milestones related to secure bonding and attachment.
Making these necessary shifts in the child health care system is an exciting but daunting prospect. Luckily, there are many people in the field dedicated to this work who are inching the needle forward every day, including representatives from 12 pediatric practices and six family advisors across the country engaging in the ACHT learning community. Together we have a long way to go, but we are committed to sharing what we learn along the way. Look for new resources and tools on CHCS.org.