Integrating Healthcare and Early Childhood Systems Requires Capacity and Expertise

Pediatric well-child visits represent a critical, often untapped opportunity to ask families about unmet social care needs and connect them with early childhood and other community services. Innovating in this space to address social determinants of health, early childhood organizations are increasingly building healthcare partnerships with the goal of increasing family access to services and preventing challenges from becoming crises. However, it can be difficult to establish shared priorities between early childhood and health care, let alone reorganize care around family needs. Pediatric clinic staff are challenged by the task of asking families about their social care needs in the context of a well-child visit based on the practical logistics alone. Innovators in this work have begun to identify common barriers associated with startup, sustainability, and continuous improvement of healthcare and early childhood systems integration. Lessons learned from these innovations can enhance ongoing and future implementation and help ensure systems integration efforts align with what families actually want to support the health and well-being of their infants.

This brief is part of Chapin Hall’s evaluation of innovations designed to promote screening for contributors to toxic stress during pediatric well-child visits and connect families to early childhood and community service providers.

What We Did

Early childhood organizations in five communities are supporting the implementation of DULCE, a pediatric health innovation that brings early childhood, healthcare, and legal partners together to support families during the first six months of their newborn’s life. These organizations fund some early childhood services directly, but also act as drivers and conveners of their local community systems. We interviewed early childhood organization leaders about their experiences with DULCE and other healthcare partnerships to learn about: their vision for addressing toxic stress and promoting family protective factors; implementation experiences specific to starting up, sustaining, and scaling DULCE with healthcare partners; and current approaches to incorporating family voice when evaluating service delivery.

What We Found

We identified four key findings related to the implementation of healthcare partnerships and systems integration efforts. First, “toxic stress” language helps with forging relationships and establishing shared priorities between early childhood and healthcare partners. Second, specific types of staff capacity and community-specific expertise are needed to start up and sustain screening and referral for social determinants of health as part of routine well-child visits. Third, reorganizing care around family needs involves more than program implementation; it involves negotiating healthcare and early childhood goals and service approaches that can conflict. Finally, systematically capturing family voice can add critical insights to guide the ongoing improvement of the partnerships and ensure that this work is aligned with family goals.

What It Means

Well-child visits offer a unique opportunity to reach all families at a critical time for healthy child development. However, adding screening and referral for social determinants of health is a significant lift in terms of capacity and expertise. It also challenges provider and family expectations about what the well-child visit is—and isn’t. Consequently, effective implementation of healthcare and early childhood systems integration requires more than asking families about their social care needs and protective factors. Resources and attention must be directed toward establishing shared priorities, realigning policies and practices, and systematically incorporating family voice into decision making to ensure that healthcare partnerships increase family access to early childhood and community services.

Recommended Citation
Spain, A. K., Brown, A. R., & Sander, A. (2020). Healthcare and early childhood systems integration in practice. Chicago, IL: Chapin Hall at the University of Chicago.
Healthcare and early childhood systems