Last month, the February 17 issue of Frontiers in Health Services featured a pathbreaking research paper entitled Sustaining and Scaling a Clinic-based Approach to Address Health-Related Social Needs.
This paper shows how DULCE teams used continuous quality improvement approaches to sustain the DULCE intervention and to introduce it to new clinics. Remarkably, most (87%) of families had used the resources they sought—and DULCE had offered—to address their health-related social needs.
DULCE offers a novel cross-sector team as part of healthcare for families with infants. Led by a specially-trained community health worker, called a DULCE family specialist, the team includes a medical provider, a mental health provider, public interest law advocate, and clinic administrator, and is embedded within the local early childhood system. Previous published research has shown the effectiveness of the DULCE approach at pilot sites. This new paper shows how DULCE teams sustained these early results and developed an efficient plan to add new clinical sites.
These findings are significant to practice transformation stakeholders because:
- Successful large-scale dissemination of evidence-based interventions is a key challenge to improving population health outcomes: many interventions that demonstrate effectiveness in small-scale pilot studies are never implemented widely in the real world. This study showed that a strategy to invest intensively in an initial phase of scale and then taper implementation support in a second phase sustained improvements in phase one sites and achieved similar improvements in second-phase new sites.
- While expectations to screen for health-related social needs have led to increased identification of families with unmet HRSN, many healthcare delivery systems struggle to reliably refer families to appropriate, available resources. There is limited evidence for how to support families to successfully access available resources. This study demonstrates a family-centered, cross-sector approach that successfully identified large numbers of families with unmet HRSN needs and successfully supported nearly 90% of those families to access HRSN resources.
- In the pediatrics context, this learning about successful HRSN screening and resource connection/usage is timely and valuable. The AAP’s Bright FuturesTM 4th Edition guidelines include screening families for HRSN. This new standard of care has important implications for both short-term outcomes and longer-term protective factors.
More broadly, these findings are important for the early childhood ecosystem because:
- Material hardship among U.S. children and their families remains staggeringly high, and COVID-19 national and public health emergency provisions that bolstered elements of the socio-economic ‘safety net’ will expire on May 11, 2023;
- Nationally, efforts to integrate social care within healthcare delivery systems are frustratingly opaque, potentially reflecting system-level barriers to which these findings might be responsive (in and beyond pediatrics); and
- There is broad recognition that cross-sector strategies are not only necessary but urgent to advance child and family health, well-being and flourishing.
DULCE (Developmental Understanding and Legal Collaboration for Everyone) is a universal, evidence-based pediatric care approach. It supports healthy newborn development, partners with families of infants to meet their social needs and promotes healthy communities.
The evidence for DULCE’s impact—reaching families, workforce members, clinics, and systems—has grown steadily over the last 8 years. This latest published research, focused on child health systems strengthening, joins a compelling portfolio of DULCE evidence published in a range of system-(re)building contexts:
- Pediatric care innovation
- Access to justice innovation
- Social care implementation in primary care (for more on the significance of this research, check out this Oct. 2021 CSSP blog)
- Pediatric medical home innovation
- Child welfare system reform (forthcoming in early 2023 in a special edition of the Child Welfare Journal of Policy, Practice and Program)
To learn more about DULCE, contact Patsy Hampton, Senior Associate and EC-LINC Director, Center for the Study of Social Policy, at firstname.lastname@example.org.
The paper covered in this blog was co-authored by MaryCatherine Arbour, Placidina Fico, Baraka Floyd, Samantha Morton, Patsy Hampton, Jennifer Murphy Sims, Sidney Atwood, and Robert Sege. Author affiliations can be found here.