Introduction: Addressing the Millennial Morbidity—The Context of Community Pediatrics

Palfrey, Judith S.; Tonniges, Thomas F.; Green, Morris; Richmond, Julius B.

doi:10.1542/peds.2004-2825b

Cited by 101 publications

(69 citation statements)

References 20 publications

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“…Research has confirmed this finding with recent studies demonstrating that poverty, and the unmet basic needs that result from it, results in greater susceptibility to disease and poorer health across the life span. [3][4][5][6]23,[28][29][30][31][32][33][34][36][37][38] Despite numerous leaders in the field advocating for addressing social needs as part of primary care [9][10][11][12]39 and professional guidelines emphasizing the need to address social determinants, [13][14][15][16][17] there has been little evidence to help guide this practice. 27,40 A previous study by our group demonstrated that a similar system can lead to more discussion and referrals for family psychosocial problems by pediatric trainees.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8] For decades, leaders in the field of pediatrics have argued that addressing a child's social needs falls within the purview of the child health provider. [9][10][11][12] Numerous American Academy of Pediatrics policy statements and Bright Futures health supervision guidelines support this view and have been published in an effort to reinforce this practice. [13][14][15][16][17] To date, however, there has been limited interventional research on how to address basic social needs during the delivery of pediatric primary care.…”

Section: What This Study Addsmentioning

confidence: 99%

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Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

et al. 2015

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OBJECTIVE: To evaluate the effect of a clinic-based screening and referral system (Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education [WE CARE]) on families' receipt of community-based resources for unmet basic needs. METHODS:We conducted a cluster randomized controlled trial at 8 urban community health centers, recruiting mothers of healthy infants. In the 4 WE CARE clinics, mothers completed a self-report screening instrument that assessed needs for child care, education, employment, food security, household heat, and housing. Providers made referrals for families; staff provided requisite applications and telephoned referred mothers within 1 month. Families at the 4 control community health centers received the usual care. We analyzed the results with generalized mixed-effect models.RESULTS: Three hundred thirty-six mothers were enrolled in the study (168 per arm). The majority of families had household incomes ,$20 000 (57%), and 68% had $2 unmet basic needs. More WE CARE mothers received $1 referral at the index visit (70% vs 8%; adjusted odds ratio [aOR] = 29.6; 95% confidence interval [CI], 14.7-59.6). At the 12-month visit, more WE CARE mothers had enrolled in a new community resource (39% vs 24%; aOR = 2.1; 95% CI, 1.2-3.7). WE CARE mothers had greater odds of being employed (aOR = 44.4; 95% CI, 9.8-201.4). WE CARE children had greater odds of being in child care (aOR = 6.3; 95% CI, 1.5-26.0). WE CARE families had greater odds of receiving fuel assistance (aOR = 11.9; 95% CI, 1.7-82.9) and lower odds of being in a homeless shelter (aOR = 0.2; 95% CI, 0.1-0.9).CONCLUSIONS: Systematically screening and referring for social determinants during well child care can lead to the receipt of more community resources for families. WHAT'S KNOWN ON THIS SUBJECT:Although pediatric professional guidelines emphasize addressing a child' s social environment in the context of well child care, it remains unclear whether screening for unmet basic needs at visits increases low-income families' receipt of community-based resources. WHAT THIS STUDY ADDS:This study demonstrates that systematically screening and referring for social determinants of health during primary care can lead to the receipt of more community resources for families.

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Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

et al. 2015

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“…88,90,91 Over more than half a century, this dialogue has focused on the need for family-centered, community-based, culturally competent care for children with developmental disabilities, behavior problems, and chronic health impairments, as well as the need for a broader contextual approach to the challenges of providing more effective interventions for children living under conditions of poverty, with or without the additional complications of parental mental illness, substance abuse, and exposure to violence. 10 As the debate has continued, the gap between the call for comprehensive services and the realities of day-to-day practice has remained exceedingly difficult to reduce. Basic recommendations for routine developmental screening and referrals to appropriate community-based services have been particularly difficult e240…”

Section: Defining a Distinctive Niche For Pediatrics Among Multiple Ementioning

confidence: 99%

“…9 Most recently, increasingly complex mental health concerns; the adverse effects of television viewing; the influence of new technologies; epidemic increases in obesity; and persistent economic, racial, and ethnic disparities in health status have been called the "millennial morbidities." 10 Advances in the biological, developmental, and social sciences now offer tools to write the next important chapter. The overlapping and synergistic characteristics of the most prevalent conditions and threats to child well-being-combined with the remarkable pace of new discoveries in developmental neuroscience, genomics, and the behavioral and social sciences-present an opportunity to confront a number of important questions with fresh information and a new perspective.…”

Section: Introductionmentioning

confidence: 99%

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Shonkoff¹,

Siegel²,

Dobbins³

et al. 2012

Pediatrics

3,877

2,375

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Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.

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“…Social and environmental degradation, [20][21][22][23]31,32 discrimination and marginalization of children, 7,8 and climate change and globalization [65][66][67][68] are among the factors that contribute to this transformation of children and childhood and the millennial morbidities that affect them. 69 The relevance and importance of child health equity to the well-being of children, families, communities, and society in the United States and throughout the world cannot be overstated. These and other societal transitions will require new and expanded roles and functions of pediatricians if pediatrics is to remain viable and relevant to the health and well-being of children.…”

Section: Relevance Of Child Health Equitymentioning

confidence: 99%

Health Equity and Children's Rights

2010

Pediatrics

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Many children in the United States fail to reach their full health and developmental potential. Disparities in their health and well-being result from the complex interplay of multiple social and environmental determinants that are not adequately addressed by current standards of pediatric practice or public policy. Integrating the principles and practice of child health equity—children's rights, social justice, human capital investment, and health equity ethics—into pediatrics will address the root causes of child health disparities. Promoting the principles and practice of equity-based clinical care, child advocacy, and child- and family-centered public policy will help to ensure that social and environmental determinants contribute positively to the health and well-being of children. The American Academy of Pediatrics and pediatricians can move the national focus from documenting child health disparities to advancing the principles and practice of child health equity and, in so doing, influence the worldwide practice of pediatrics and child health. All pediatricians, including primary care practitioners and medical and surgical subspecialists, can incorporate these principles into their practice of pediatrics and child health. Integration of these principles into competency-based training and board certification will secure their assimilation into all levels of pediatric practice.

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Introduction: Addressing the Millennial Morbidity—The Context of Community Pediatrics

Cited by 101 publications

References 20 publications

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

Addressing Social Determinants of Health at Well Child Care Visits: A Cluster RCT

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Health Equity and Children's Rights

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