Transforming The U.S. Child Health System

Halfon, Neal; DuPlessis, Helen; Inkelas, Moira

doi:10.1377/hlthaff.26.2.315

Cited by 71 publications

(52 citation statements)

References 12 publications

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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.…”

Section: Defining a Distinctive Niche For Pediatrics Among Multiple Ementioning

confidence: 99%

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Shonkoff¹,

Siegel²,

Dobbins³

et al. 2012

Pediatrics

3,857

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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Section: Defining a Distinctive Niche For Pediatrics Among Multiple Ementioning

confidence: 99%

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Shonkoff¹,

Siegel²,

Dobbins³

et al. 2012

Pediatrics

3,857

2,375

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6][7][8] In the past decade, numerous studies have addressed the growing number of anticipatory guidance topics, 9 disparities in access, 10,11 and discrepancies in quality. 2,[12][13][14] The new Bright Futures guidelines 15 provide the pathway for many advancements, but as the history of well-child care shows, pediatrics will continue to strive for additional improvement.…”

mentioning

confidence: 99%

What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

et al. 2009

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WHAT'S KNOWN ON THIS SUBJECT:Schor called on pediatricians to rethink well-child care. Gaps exist between traditional wellchild care and contemporary needs and pressures. A key, but largely missing, perspective in the rethinking of discussions has been that of parents. WHAT THIS STUDY ADDS:In this qualitative study, we asked parents to address several core issues including why they attend well-child care visits, the aspects of care they find most valuable, and what changes could enhance the well-child experience.abstract OBJECTIVE: The content and systems surrounding well-child care have received increasing attention, and some propose that it is time to rethink both the delivery structure and central themes of well-child visits. A key, but largely missing perspective in these discussions has been that of parents, whose experiences and expectations are central to developing approaches responsive to family needs. In this study, we asked parents to address several core issues: why they attend wellchild visits; aspects of well-child care that they find most valuable; and changes that could enhance the well-child care experience. METHODS: Twenty focus groups with parents (n ϭ 131 [91% mothers])were conducted by using a semistructured interview guide. Verbatim transcripts were coded for key words, concepts, and recurrent themes. RESULTS:Primary reasons for visit attendance included reassurance (child and parent) and an opportunity to discuss parent priorities. Families valued an ongoing relationship with 1 clinician who was childfocused and respected parental expertise, but continuity of provider was not an option for all participants. Suggestions for enhancement included improved promotion of well-child care, greater emphasis on development and behavior, and expanded options for information exchange. CONCLUSIONS:As the consumers of care, it is critical to understand parents' needs and desires as changes to the content and process of well-child care are considered. Taking into account the multifaceted perspectives of families suggests both challenges and opportunities for the rethinking discussion. Pediatrics 2009;124:858-865

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“…Different models of care may be more efficient or effective in addressing the major childhood drivers of adult disease than current common practices; a few are summarized in the following discussion. [86][87][88][89] One-Stop Shopping Approach…”

Section: What Is the Future For Wcc?mentioning

confidence: 99%

Does Well-Child Care Have a Future in Pediatrics?

2013

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The most common adult chronic diseases affect 1 in 3 adults and account for more than three-quarters of US health care spending. The major childhood drivers of adult disease are distinctly nonmedical: poverty, poor educational outcomes, unhealthy social and physical environments, and unhealthy lifestyle choices. Ideally, well-child care (WCC) would address these drivers and help create healthier adults with more productive lives and lower health care costs. For children without serious acute and chronic medical problems, however, traditional pediatric preventive services may be largely ineffective in addressing the outcomes that really matter; that is, improving lifelong health and reducing the burden of adult chronic disease. In this article, we examine what role WCC has in addressing the major childhood drivers of adult disease and consider various models for the future of WCC within pediatrics.

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Transforming The U.S. Child Health System

Cited by 71 publications

References 12 publications

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

The Lifelong Effects of Early Childhood Adversity and Toxic Stress

What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

Does Well-Child Care Have a Future in Pediatrics?

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