Determinants of Health and Pediatric Primary Care Practices

Abstract

More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of povertyrelated risks in ways that promote long-term health and well-being for children.abstract

Financial and Social Hardships in Families of Children with Medical Complexity

“…At-risk patients and families can be connected to appropriate resources both within the healthcare system as well as within the community. 38-40 Many hospitals and primacy care centers serving families of CMC have access to medical-legal partnerships, financial counseling services, and/or mental health services. 41-44 These resources, in conjunction with enhanced care coordination and home caregiver support may be particularly important for families of CMC affected by financial and social hardship.…”

The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families

“…98,99 They encourage routine assessment of factors like race/ethnicity, social isolation, parental educational attainment, financial strain, and residential address (to enable linkage to complementary information like neighborhood-level median household income). 98,100 Evaluation of SDH-related risks and assets using one of the many available screening tools [101][102][103][104] could influence clinical care from the moment of first patient/ family contact, ensuring that supports are deployed to match identified needs. Assessments could start prenatally in obstetrical clinics and extend across the NICU stay to bring an awareness of context to the bedside.…”

Stripping the Wallpaper of Practice: Empowering Social Workers to Tackle Poverty

“…Exemplar home visiting programmes build economic self-sufficiency improving parent knowledge, skills and motivation, and providing practical links to adult education and job training (Minkovitz et al 2016). Primary care parenting interventions have the potential to reach large numbers of children (Cates et al 2016) and the American Academy of Pediatrics has been vocal in policy, legislation, education and leadership (Beck et al 2016), clearly demonstrating a strong and dynamic advocacy role for their members. This is a good example of how professionals in the health and social care sectors can address social justice and inequality beyond the confines of policy or limited resources.…”