Child health equity and primary care.

Abstract

Child health disparities in terms of access to high-quality physical and behavioral health services and social needs supports are rampant and pernicious in the United States. These disparities reflect larger societal health inequities (social injustice in health) and lead to preventable populationspecific differences in wellness outcomes with marginalized children facing substantial and systematically disproportionate health burdens. Primary care, and specifically the pediatric patient-centered medical home (P-PCMH) model, is a theoretically well-positioned platform to address whole-child health and wellness needs, yet often does so in a way that is inequitable for marginalized populations. This article delineates how the integration of psychologists within the P-PCMH can advance child health equity. This discussion emphasizes roles (i.e., clinician, consultant, trainer, administrator, researcher, and advocate) that psychologists can undertake with explicit intentionality toward promoting equity. These roles consider structural and ecological drivers of inequities and emphasize interprofessional collaboration within and across childserving systems of care using community-partnered shared decision-making approaches. Owing to the multiple intersecting drivers implicated in health inequities-ecological (e.g., environmental and social determinants of health), biological (e.g., chronic illness, intergenerational morbidity), and developmental (e.g., developmental screening, support, and early intervention)the ecobiodevelopmental model is used as an organizing framework for psychologists' roles in promoting health equity.

Behavior Problems in Low-Income Young Children Screened in Pediatric Primary Care

“…It is also possible that Black or African American caregivers are reluctant to report concerns about their child’s behavior for fear of the response of health care professionals (eg, may result in reports to child protective services as there is disproportionately higher contact among Black or African American families compared with White families due to structural racism) . Our findings underscore the need for increased cultural sensitivity and understanding of Black or African American families and other historically marginalized populations in pediatric primary care both in terms of clinical practice and research …”

“…20 Our findings underscore the need for increased cultural sensitivity and understanding of Black or African American families and other historically marginalized populations in pediatric primary care both in terms of clinical practice and research. 21,22 Being male was associated with the 3 elevated trajectories compared with the LS trajectory group. Males were also more represented in the HI vs MD groups although being female was associated with membership in the MD vs LI groups.…”

Kids are all in the same storm but not in the same boat.

“…More broadly, integrated pediatric primary care which includes behavioral health services is a nearly universal approach to advancing healthy development and equity (McCabe et al, 2020; Shahidullah et al, 2023). Specific programs within primary care settings have shown special promise and implementation to scale with fidelity.…”

Disparities in accessing specialty behavioral health services during the COVID-19 pandemic and why we need pediatric integrated primary care

“…Despite the benefits of IPC, research has recently started to acknowledge the complexities of navigating through IPC levels of care and SBH (50) systems, and the resultant racial and ethnic disparities that emerge (34,38,51,52). Even in the adult behavioral health literature there is growing acknowledgment that IPC research has included sizable portions of participants from communities of color but has generally not reported population specific outcomes despite lack of clarity on disparate access to care (53).…”