Health equity is central to DULCE (Developmental Understanding and Legal Collaboration for Everyone), a universal, evidence-based pediatric care approach that addresses the social determinants of health and supports early relational health for families with infants. By strategically expanding in communities that are under-resourced and have been marginalized by inaccessible health care systems, DULCE supports families with infants to ensure they have a fair and just opportunity to be as healthy as possible. Several other strategies advance DULCE’s commitment to health equity such as an Interdisciplinary Team that brings together a legal partner, early childhood systems representative, medical provider, Family Specialist, and mental health clinician to connect families to concrete supports. The linchpin of the DULCE approach is the Family Specialist, a specialized Community Health Worker who is from the community and has similar life experiences to that of many DULCE families. By serving as the bridge among families, community support, and health systems, Family Specialists build trusting relationships with families and honor them as key decision-makers and experts of their newborn. This reaffirms the power families and their communities hold.
One Family Specialist’s involvement in her community in Oakland, CA, boldly embodies DULCE’s commitment to equity. The Alameda Health System (AHS) recently established a new Health Equity, Diversity, and Inclusion Committee that aims to bring a systematic approach and vision to advancing health equity, diversity, and inclusion at all levels of its system. By both looking beyond the type and quality of services AHS provides and inward at the AHS culture of diversity and inclusion, the committee’s mission is to enhance the well-being of, and reduce the disparities in health care experienced by, underrepresented and marginalized patients in the community. Through a highly selective process, Laura Lopez, a DULCE Family Specialist at the Highland Pediatric Clinic, was selected to serve as part of this committee. As an organizer and health leader, Laura is committed to improving the lives of infants and their families who come from immigrant backgrounds and face challenges in connecting to confusing or inaccessible resources. Her advocacy is informed by her previous status as an undocumented immigrant who first moved to the United States at the age of 18. Having worked as a house cleaner and child care worker, she has firsthand experience with the challenges and discrimination faced by many other immigrant workers and workers with low-income backgrounds.
Read more about Laura’s work as a Family Specialist and as a member of Alameda Health System’s Health Equity, Diversity, and Inclusion Committee below.
Please tell us about your work as part of the Health Equity, Diversity, and Inclusion Committee.
I was previously an Executive Director for a non-profit for 10 years, so I’ve been working in the Oakland community for awhile. The work I do is more “on the ground” with immigrants, refugees, or those experiencing homelessness. It’s all about connecting them with resources and understanding how different systems are not working how they’re supposed to. When I learned about the Health Equity, Diversity, and Inclusion Committee, I wanted to apply because I knew families face a lot of barriers when trying to access care.
Within the committee, I am a part of the Equity of Care task force. The task force is evaluating the different kinds of programs that are implemented in the Alameda Health System and the populations these programs are serving. For example, we are examining how we are targeting populations with diabetes. It’s a great experience because I get to learn about a larger health system that serves a diverse population. Being part of the committee is also about bringing to the table the diversity and representation of communities. When any big changes are made, we need to make sure diverse voices are at the table and feel included. For example, televisits are great for some families, but not great for other families who might speak another language or don’t have access to a stable internet connection.
How has DULCE informed your work as part of this committee?
As a DULCE Family Specialist, I know the importance of communicating with different departments. We have a birthing center and a lot of the babies come to our pediatric department. We’re constantly trying to figure out how to have a relationship with them. For moms that might experience postpartum depression, how am I going to get in touch with a social worker?
DULCE is not new for me. The way I implement DULCE is the same way I provided care with my previous organization. DULCE is supporting the infant and also the other individuals around the infant. Do you have a house to stay? Do you have problems with immigration? This approach should not just be for DULCE families but for anyone who comes to the hospital.
How has COVID-19 impacted your work?
In the beginning, a lot of families were feeling lonely and isolated. Some families didn’t want to go to the clinic. The pandemic has essentially increased all the needs from before the pandemic, especially for food, diapers, and housing needs. The way we do the day-to-day work has also changed. I am not able to see families in-person and everything is by phone. I’ve never physically met many of the families I’ve been working with since the pandemic began.
When I do in-person visits, you hear and see the family, and it shows you how the family is. By phone, it takes more effort to hear the concerns and needs of the family. It’s a little bit harder, but I still feel like I have a lot of trust with the families I work with.
What are the strengths of DULCE and how does it inform the way you approach your work with families?
DULCE can show it’s possible to support a family and everyone around that person, not just the individual. I advocate for resources for the pediatric department because the department doesn’t have a lot of resources. I believe DULCE has the power to invest more in pediatrics. It’s helping the infant and family not to have more complications later in life. Families can face many challenges when taking care of their babies. Undocumented families also face a lot of barriers because they can’t receive unemployment benefits or disability benefits. Other programs give a phone number to a family and that’s it, but DULCE is a back-and-forth relationship.
When working with families, I don’t want to implement my own agenda. My agenda is what the family is telling me to do. It’s how we empower the people we serve—empower the families to speak up, empower the families to ask for help, empower the families to say yes or no. I want to bring the family stories to the table.