CDC Grand Rounds: Addressing Health Disparities in Early Childhood.

Research suggests that many disparities in overall health and well-being are rooted in early childhood (1,2). Stressors in early childhood can disrupt neurologic, metabolic, and immunologic systems, leading to poorer developmental outcomes (1). However, consistent, responsive caregiving relationships and supportive community and health care environments promote an optimal trajectory (3,4). The first 8 years of a child's life build a foundation for future health and life success (5-7). Thus, the cumulative and lifelong impact of early experiences, both positive and negative, on a child's development can be profound. Although the health, social service, and education systems that serve young children and their families and communities provide opportunities to support responsive relationships and environments, efforts by these systems are often fragmented because of restrictions that limit the age groups they can serve and types of services they can provide. Integrating relationship-based prevention and intervention services for children early in life, when the brain is developing most rapidly, can optimize developmental trajectories (4,7). By promoting collaboration and data-driven intervention activities, public health can play a critical role in both the identification of at-risk children and the integration of systems that can support healthy development. These efforts can address disparities by reducing barriers that might prevent children from reaching their full potential.

Social Network Analysis as a Tool to Inform a Children's Hospital's Efforts to Improve Population Health.

OBJECTIVES: A children's hospital explored the feasibility and utility of social network analysis as a tool for system building in community child health, to identify gaps and opportunities in community partnerships, and to assess its role as a contributor to collective impact. METHODS: We employed social network analysis with the PARTNER survey to assess relationships among community-based organizations and a children's hospital's community-oriented programs. We utilized a two-stage, snowball sampling strategy to identify community partners. We analyzed social capital, network density, degree centralization, perceived trust, and perceived value. Network mapping depicted the hospital programs' relationships with community partners. RESULTS: Of the 153 contacted potential respondents, 76 responded for a response rate of 50%. Respondents reported a total of 1116 ties, ranging in strength from awareness and cooperation to coordination and integration. Approximately 60% of network members could reach 100 or more members in 2 steps or less. The overall network trust score was 74%. Network mapping indicated that hospital programs enhance bonding relationships within sectors, bridge gaps between partners from different sectors, and provide linkages to resources such as funders. Deficits in bonding, bridging, and access to funding are evident when the hospital's programs are omitted from network maps. CONCLUSIONS: Findings support the feasibility and utility of social network analysis as a tool for system building in community child health. The study demonstrates the potential of a children's hospital's programs to provide social capital in the form of bonding, bridging, and linking relationships.

Analysis of Care Coordination Needs for Families of Children with Special Health Care Needs.

OBJECTIVES: To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors. METHODS: CC service data were extracted and analyzed from patient encounters over 4 years (2009-2013) in a department database. This included descriptive information about referrals and linkages to medical, dental, and behavioral health providers and to state, private, and community agencies. Diagnostic classifications and CC sectors were defined to enable categorization. RESULTS: A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors. CONCLUSION: Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.

Screening for basic social needs at a medical home for low-income children.

The goals of this cross-sectional study were to (a) describe the prevalence of 5 basic social needs in a cohort of parents attending an urban teaching hospital-based pediatric clinic, (b) assess parental attitudes toward seeking assistance from their child's provider, and (c) examine resident providers' attitudes and behaviors toward addressing these needs. Parents (n = 100) reported a median of 2 basic needs at the pediatric visit. The most common was employment (52%), followed by education (34%), child care (19%), food (16%), and housing (10%). Most parents (67%) had positive attitudes toward requesting assistance from their child's pediatrician. The majority of resident providers (91%) believed in the importance of addressing social needs; however, few reported routinely screening for these needs (range, 11% to 18%). There is great potential for assisting low-income parents within the medical home. Further practice-based interventions are needed to enhance providers' self-efficacy to screen and address low-income families' needs at pediatric visits.

Can We Identify Parents Who Do Not Verbally Share Concerns for Their Children's Development?

OBJECTIVE: We aimed to identify characteristics of parents who do not voice developmental concerns when prompted by their children's nurse and/or primary care provider (PCP), despite reporting concerns on parent-completed questionnaires. METHODS: We reviewed 376 medical records of children seen for a 9-month well-child visit in an urban pediatric clinic between September 2011 and December 2012 for sociodemographic variables hypothesized to affect parents' sharing of developmental concerns: the child's birth order and gender; parents' education level, employment, relationship status, and primary language; and family size and racial/ethnic background. The target population was parents who reported concerns on the Parents' Evaluation of Developmental Status (PEDS), a routinely administered, parent-completed screening questionnaire. We subdivided parents who reported concerns on the PEDS (N = 86) based on whether they voiced developmental concerns when prompted by their children's nurse and/or PCP. Two-sided Fisher's exact tests and logistic regression evaluated the relationship between sociodemographic variables and parents' voicing of developmental concerns. RESULTS: Only parent education approached significance, as parents with less than a high school education (

A Population Health Approach to System Transformation for Children's Healthy Development.

What if the goal of child health services was not "merely" treating, or even preventing, childhood diseases and disorders, but was expanded to that of promoting children's optimal healthy development? Pediatrics has evolved from an exclusive focus on the treatment of illness to the opportunity to promote children's healthy development. This evolution has profound implications for the content of child health services and programs, for system transformation, and for public policy. Enhanced understanding of the impact of social determinants on children's health and developmental outcomes underscores the importance of an evolving framework for system transformation with key policy implications.