Guide to Transforming Care for Young Children in Community Health Centers
A growing number of child health experts, health policy leaders, early childhood system builders, national organizations, federal agencies, thought partners, innovators, and parent experts are aligning around a vision for transforming early child health services and systems that equitably support all families of young children with the services and supports they need to flourish. Successfully transforming primary care for children toward early relational health requires advancing high-performing medical homes. In recent years, child health transformation has been a topic of active research and innovation that now offers guidance for changing practice, adopting new financing strategies, advancing meaningful measurement, and changing the culture of care.
Nurture Connection’s Guide to Transforming Care for Young Children in Community Health Centers, authored by Kay Johnson and David W. Willis, MD, FAAP, is a state-of-the-art resource for child health care transformation and specifically targets achievable advancements for community health centers. Readers will find research summaries, best practices, and policy insights related to developmental screening, team-based care, high-performing medical homes, Medicaid, quality improvement, and more.
The Role of Health Centers in Serving Young Children
The 1,400 federally funded community health centers nationwide are an important source of primary care for approximately 2.8 million children under age 6. Health centers are also disproportionately likely to serve young children living in poverty and those with Medicaid or no insurance, with Black, Indigenous, and Hispanic children overrepresented in those groups.
Responsive, family-centered early childhood developmental services and high-quality primary care in health centers hold great potential for filling gaps in access and reducing disparities in outcomes by race/ethnicity, income, and insurance status. Health centers are pivotal in providing high-quality early childhood developmental health services that foster optimal child development, promote early relational health, and help assure lifelong well-being for children, families, and communities.
In August 2023, the Health Resources and Services Administration awarded 151 community health centers to advance early childhood developmental services. The ECDHS: Evidence to Impact Center provides specialized training and technical assistance to the grantees to help them meet their grant objectives:
- Increase the number of children ages 0-5 who receive recommended developmental screening;
- Increase the number of children and their families who receive assistance in gaining access to appropriate follow-up services for identified risks and concerns; and
- Build early childhood developmental expertise into their primary care teams.
Lessons From Research in Exemplary Practices
- Partner with families and design efforts that are family-centered and strengths-based.
- Maximize team-based care and specify roles for all team members.
- Apply quality improvement (QI) methods to increase rates for screening and effective referrals.
- Use electronic health records and other technology as needed.
- Set up workflows for all five recommended types of screening in well-child visits.
- Don’t forget referral and care coordination processes.
- Identify and train staff who will engage and support families (e.g., community health workers, care coordinators, family peer navigators, parent coaches).
- Give attention to equity in access, workforce cultural congruency, and linguistic appropriateness.
- Use measurement to drive quality and performance.
The strong body of research summarized in the guide confirms that community health centers, other clinics (e.g., children’s hospitals, academic medical center clinics), and private pediatric practices can dramatically improve their rates of recommended screening, referral, and family engagement.
Studies point to the impact of quality improvement projects, clinician and staff training, the use of electronic records, and enhanced care coordination and support for families. The use of evidence-based models designed to improve child development is a complementary strategy, and the importance of partnering with parents, using strengths-based approaches, and promoting early relational health is also underscored.
Design for a High-Performing Medical Home for Young Children
The design for an advanced, team-based, high-performing medical home focuses on three core areas to be operationalized and incorporated into practice. Medicaid and CHIP can finance services in each area to support and sustain high-performing medical homes.
Redesigned Well-Child Visits
- Holistic, team-based care
- Comprehensive well-child visits based on Bright Futures guidelines and EPSDT
- Family-centered, strengths-based, relational, holistic approaches
- Recommended monitoring and screening for development, social-emotional health, perinatal depression, and social drivers of health (SDOH)/socially related health needs (SHRN)
Relational Care Coordination
- Routine care coordination as part of the medical home
- Intensive care coordination for more complex medical conditions and social needs
- Relational care coordination staff (e.g., community health workers, peer navigators)
- More effective responses to needs, completed referrals, and partnership with the community
Other Services and Enhanced Supports
- Co-located programs in primary care to promote early relational health and development (e.g., DULCE, HealthySteps, PlayReadVIP)
- Integrate mental health in team-based care and community supports
- Families engaged as advisors and partners
- Referrals and/or linkages to other services (e.g., home visiting, early intervention, dental care, early care and education, parent-child mental health therapy, nutrition)
Adapted from: Willis DW, Paradis N, Johnson K. The paradigm shift to early relational health: A network movement. Zero to Three. 2022;42(4):22-30. Johnson K, Bruner C. A Sourcebook on Medicaid’s Role in Early Childhood: Advancing high performing medical homes and improving lifelong health. Child and Family Policy Center. 2018. https://www.inckmarks.org/docs/pdfs_for_Medicaid_and_EPSDT_page/SourcebookMEDICAIDYOUNGCHILDRENALL.pdf
Guide to Transforming Care for Young Children in Community Health Centers
Nurture Connection • nurtureconnection.org
