Good Medicine For Healthy Child Development: Nurturing Relationships

In the United States today, some 27,000 pediatricians provide care to 24 million children under the age of six. Many pediatric practitioners are overburdened, struggling to provide care to a panel ranging from 2,000 to 3,000 patients, which often requires them to see anywhere from 10 to 30 patients a day. With these numbers, the average provider spends just 10 minutes interacting with the child and their parent during a well-child visit. (We define “parent” as any adult who is serving in the primary caregiver role. In some families that person may be a grandparent, relative, foster parent, or guardian.) In that short amount of time, health care providers must update vaccination records, check growth charts, and care for the ever-present ailments of childhood, from sleep disruptions to ear infections.

Yet, in recent years it has become clear that families need and deserve support to care for more than just the physical health of their children. What if pediatric care could be transformed to actively partner with parents to better support children’s healthy social and emotional development, too?

That is the question that drives the Pediatrics Supporting Parents (PSP) national funder collaborative. To date, six national funders (the Conrad N. Hilton Foundation, Einhorn Collaborative, Overdeck Family Foundation, Perigee Fund, the David and Lucile Packard Foundation, and the W.K. Kellogg Foundation) have committed a total of $13.25 million over five years to invest in aligning clinical practice with a mounting body of evidence that demonstrates the benefits of leveraging pediatric well-care to support improved social and emotional outcomes in young children and to strengthen parent–child relationships by partnering with providers and parents.

Significance Of Healthy Social And Emotional Development

The first years of life, marked by rapid brain development, are a period of both opportunity and sensitivity. Healthy social and emotional development centers on very young children’s emerging ability to form secure relationships, experience and regulate their emotions, explore the world around them, and learn. A child’s social and emotional well-being impacts their ability to lead a healthy life—physically and emotionally—into adulthood and has been shown to influence their capacity to thrive in school.

One critical factor influencing a child’s healthy development is the nurturing relationships they form with their primary caregivers. Through these close bonds, babies and toddlers learn to develop their sense of self and regulate their emotions. When children have strong, healthy bonds with their parents or caregivers, those relationships also serve as a buffer against everyday stressors as well as more chronic adversity that children may experience due to structural racism and poverty.

The Context

Realizing PSP’s vision requires addressing both challenges in the health care system and in broader society. The COVID-19 pandemic has strained our public health infrastructure, fueled a mental wellness crisis for parents and children, and fragmented our social networks in ways that will likely have long-lasting negative impacts. For families of color, who comprise 48 percent of all births, the pandemic has only intensified longstanding health and racial inequities intrinsic to care in America. Even before COVID-19, pediatric health care transformation was a challenging area of focus as most cost savings to the health system are found in adults with chronic and/or severe health conditions, as compared to their younger counterparts who are typically healthier. Further, little priority is placed on disease prevention and health promotion, given that most savings to the health care system (and/or other sectors) are accrued in the future.

Despite these challenges, the pandemic has motivated health care innovations and brought greater attention to (1) children’s social and emotional health; (2) how nurturing relationships can help a child cope with stress and adversity; and (3) the systems that continue to drive racial and health inequities.

PSP’s Approach To Systems Change

To transform the standard of early well-child care, PSP is addressing a number of structural barriers in children’s health care while sharing the clinical experiences of families and providers to inform policy and systems change. Limited visit time, insufficient provider reimbursement, incompatible electronic medical records, technology inefficiencies, and insufficient clinician training all make it challenging for providers to embrace a focus on social and emotional development and nurturing parent-child relationships.

To date, PSP’s grantees have produced a summary of common practices for promoting social and emotional development in pediatrics, a financing blueprint for Medicaid and the Children’s Health Insurance Program, and a guide to help states leverage opportunities between Title V and Medicaid. These resources and more can be accessed through the PSP initiative’s website.

Each of these efforts has centered a commitment to authentic family engagement with parent leaders playing a pivotal role in the development and implementation of strategies and helping to ensure that the work is family-centered and equitable.

Families, Communities, And Equity

To achieve true and equitable population-level change, PSP is following a targeted universalism approach that centers on Black, Indigenous, and People of Color (BIPOC) families experiencing the impacts of systemic racism and community disinvestment, which manifest as health inequities. By setting a universal goal to support all children’s healthy social and emotional development and nurturing relationships but using strategies that target specific populations, these efforts will transform care for all families.

For some children, supports might be as simple as talking to parents about reading and singing to their children or connecting families with toddler time at a library. For children affected by adverse experiences such as parental depression, housing insecurity, or separation from a parent, we must identify opportunities for additional family support that can be delivered without stigmatizing, judging, or unintentionally harming families.

Early parenting is hard even in the best of circumstances—not because of parental failures or deficiencies, but because society has not aligned systems, policies, and resources to support families with young children in the ways they need to thrive. With this in mind, PSP envisions a pediatric health system that is resourced and designed to do its part as an essential element of a larger support system.

For far too long, philanthropic funders and leaders of health systems have seen data and listened to stories about how structural forces negatively impact BIPOC families’ access to and experiences with health care. The funders of PSP are committed to focusing on systemic barriers, as well as social determinants of health, while ensuring that our investments do not exacerbate racial and health inequities.

We are excited to share that PSP recently selected five community grantees that will inform national systems work with family-engaged and community-led local pediatric practice transformation. The interplay will make the case for eventual widescale national change. While all PSP grantees share a North Star that centers parents, prioritizes BIPOC children and families, and seeks to support early social and emotional development and parent-child relationships, the road that each community takes will be co-created locally. Each site will receive a grant for a one-year planning process, followed by multiyear funding for technical assistance and implementation. Our partners are:

• Durham Partners for Early Relational Health with Duke Children’s Primary Care (North Carolina)
• Early Childhood Alliance Onondaga with Upstate Medical University (New York)
• LIFT/ACEs LA Medical–Financial Partnership with Network for Care (California)
• University of California San Francisco Center for Child and Community Health with the Ready! Resilient! Rising! (R3) Network (California)
• Washington Chapter of the American Academy of Pediatrics with Pediatrics Northwest (Washington State)

In an e-mail, Laurie Black, the director of Early Childhood Alliance Onondaga, expressed her enthusiasm to get started with the PSP Learning Community. “The Early Childhood Alliance Onondaga and Upstate Medical University are excited about working together to develop innovative approaches for strengthening pediatric care,” said Black. “These efforts will not only advance equity and early relational health for patients and families but also advance a model for elevating parents’ voices that can be shared with other communities as well as state and national partners.”

As a parent of a newborn and parent leader with the Early Childhood Alliance Onondaga, Jade McAlmont shared her enthusiasm, in an e-mail, for being part of this collaborative effort. “Children truly cannot be healthy if they don’t have healthy parents or caregivers,” said McAlmont. “When we have positive relationships with our health providers, we form a level of preventative care that protects everyone in the active triad—parents, children, pediatricians/health providers.” For McAlmont, building these relationships among parents, children, and providers is motivating. “This is what I look forward to as a parent while my son grows.”

Though being a parent is not a prerequisite for being involved in PSP, we happen to be parents and know firsthand that babies do not come with instruction manuals. We understand the benefit of helping parents and caregivers nurture children’s social and emotional health and development alongside their physical health and development—a benefit that all families want and deserve.

Over time, we have observed a decline in philanthropic investment in high-quality, equitable pediatric care. By working together for systemwide change, funders can help transform the lives of millions of children for the better.