Relational Team-Based Care that Centers Parent Voice in Pediatric Clinics

By David Willis, MD, FAAP

Pediatrics Supporting Parents (PSP) is an initiative focused on using well-child visits as a universal access point for pediatricians and parents to work together to support a child’s social and emotional well-being in the first years of life. Recognizing well-child visits as a meaningful opportunity to promote Early Relational Health (ERH), the PSP initiative is one example of the innovative ERH programming happening within a growing Nurture Connection network.

Created in 2017, PSP is a funding collective, including the Conrad N. Hilton Foundation, Einhorn Collaborative, Overdeck Family Foundation, Perigee Fund, the David and Lucile Packard Foundation, and the W.K. Kellogg Foundation. PSP is supporting five communities that represent a diversity of location and types of local healthcare systems to serve as “proof point communities (PPCs)” to demonstrate ways to transform the well-child visits as a means for enhancing ERH. These communities are acting as cocreators of PSP’s overall investment strategy and approach. The PPCs are:

  • Durham Collaborative Network for Early Relational Health | Durham County, NC
  • Early Childhood Alliance Onondaga | Onondaga County, NY
  • LIFT / ACEs LA Medical-Financial Partnership and Network of Care | Los Angeles, CA
  • UCSF – The Ready, Resilient, & Rising! Network (R3 Network) | San Francisco and Alameda Counties, CA
  • First Year Families – Washington Chapter of the American Academy of Pediatrics (WCAAP), Pediatrics Northwest | Pierce County, WA

Two members of the Washington Chapter, Mary Ann Woodruff, MD, FAAP, general pediatrician with Pediatrics Northwest, and Shayla Collins, a family partner and parent leader, are new members of Nurture Connection’s National ERH Network. Both recently shared how their teams are transforming well-child visits in Pierce County.

In speaking with parents, members of WCAAP learned that there was a fundamental need to build healthier, more trusted relationships between parents and pediatricians in order to better support a child’s social and emotional development. A necessary first step toward strengthening this partnership meant recognizing how inequitable gaps in resources and everyday racial bias impact different caregiving communities, especially Black and Brown communities, and ensuring that care providers honor, respect, listen, and support families without judgment.

To transform the current well-child visit model, Pediatrics Northwest is implementing an evidence-based pediatric primary care medical home approach by creating teams of care to support parents in clinics as soon as they begin their pediatric journey. At the center of these teams is a community health worker (CHW). CHWs act as compassionate listeners and navigators, translating and uplifting parent needs to the rest of the family’s team of care. Partnership can take a variety of forms, such as following up with parents on mental health referrals rather than putting the burden on parents. 

Dr. Woodruff shared that one of the most powerful impacts of their work is how families feel visible and respected. For example, when Spanish-speaking CHWs were hired, caregivers shared that they felt more empowered, creating a real sense of hope for their children and family’s well-being.

The WCAAP will then take the lessons learned from the clinic’s use of team-based care to help develop statewide strategies and sustainability for similar changes across the state. 

This transformation of pediatric wellness care requires financial investments and champions at the state and community levels and within clinic practice as well. Already we’re seeing policy change within Washington that will further this type of new team-of-care approach to the well-child visits. The state legislature has funded nearly 40 CHWs for two years (2022–24) to be embedded in primary care practices across the state. Six of the eight CHWs at Pediatrics Northwest are funded through this pathway, in effect, demonstrating how to advance ERH policy into practice. 

The hope for PSP and the larger Nurture Connection network is to continue to scale practices that transform the well-child visits so that they enhance ERH. Such practice changes will require supportive state and national policy — all of which must be designed with parent input and wisdom in order to ensure that families receive the care that they need and deserve.  

David Willis, MD, FAAP, and Senior Fellow at the Center for the Study of Social Policy, is a pediatrician, an Early Relational Health leader, and part of the Nurture Connection leadership.