ABSTRACT
Responsibilities for primary care clinicians are rapidly expanding ascomplexities in families' lives create increased disparities in health and developmental outcomes for young children. Despite the demands on primary care clinicians to promote health in the context of complex family and community factors, most primary care clinicians are operating in an environment of limited training and a shortage of resources for supporting families. Partnerships with evidence-based home visiting programs for very young children and their families can provide a resource that will help to reduce the impact of adverse early childhood experiences and facilitate health equity. Home visiting programs in the United States are typically voluntary and designed to be preventative in nature, although families are usually offered services based on significant risk criteria since the costs associated with universal approaches have been considered prohibitive. Programs may be funded within the health (physical orbehavioral/mental health), child welfare, early education, or early intervention systems or by private foundation dollars focused primarily on oneof the above systems (e.g., health), with a wide range of outcomes targeted by the programs and funders. Services may be primarily focused on the child, the parent, or parent-child interactions. Services include the development of targeted and individualized intervention strategies, better coaching of parents, and improved modeling of interactions that may assist struggling families. This paper provides a broad overview ofthe history of home visiting, theoretical bases of home visiting programs, key components of evidence-based models, outcomes typically targeted, research on effectiveness, cost information, challenges and benefits of home visiting, and funding/sustainability concerns. Significance for primary care clinicians isdescribed specifically and information relevant for clinicians is emphasized throughout the paper.
Subject(s)
Child Health Services , Community Networks/organization & administration , Home Care Services , Practice Patterns, Physicians'/statistics & numerical data , Preventive Health Services , Primary Health Care , Adolescent , Child , Child Health Services/history , Child Health Services/organization & administration , Child Health Services/trends , Child, Preschool , Early Intervention, Educational , Female , History, 19th Century , History, 20th Century , History, 21st Century , Home Care Services/history , Home Care Services/organization & administration , Home Care Services/trends , Humans , Infant , Infant, Newborn , Male , Parents , Pregnancy , Preventive Health Services/history , Preventive Health Services/organization & administration , Preventive Health Services/trends , Primary Health Care/history , Primary Health Care/organization & administration , Primary Health Care/trends , Quality Assurance, Health Care , Socioeconomic Factors , United States/epidemiologyABSTRACT
This article addresses the primary modifications necessary for system change to better meet the mental health needs of children under the age of three. The role of risk and resiliency factors in the young child, family and community and the necessity for a comprehensive community infant-family mental health system with a focus on the whole family are addressed. Barriers to care within early childhood systems of care are examined, including stigma, community referral and collaboration, diagnostic concerns during infancy, issues around family engagement, empowerment and partnership, funding of comprehensive and well coordinated infant-family services, workforce capacity and evaluation. Recommendations for implementation of system changes at the community and federal levels are proposed.
