DULCE

Creating family-centered systems of care

What We Work For

Developmental Understanding and Legal Collaboration for Everyone (DULCE) is transforming the way families experience health care.

DULCE is an innovative approach based in the pediatric care setting that proactively addresses social determinants of health, promotes the healthy development of infants, and provides support to their parents, all during the precious and critical first six months of life. DULCE does this by introducing a Family Specialist trained in child development, relational practice, and concrete support problem solving into the pediatric care team. Family Specialists attend well-child visits with families and providers. They get to know the families, provide peer support, and then work with the DULCE Interdisciplinary Team to connect families with resources and support.

The DULCE Interdisciplinary Team is comprised of a Family Specialist, a medical provider, a legal partner, an early childhood systems representative, a mental health representative, a project lead, and a clinic administrator. By working to address the accumulated burden of social and economic hardship, DULCE—through the Interdisciplinary Team—reduces family stress, giving families more time and energy to bond with and care for their new child.

Many conditions contribute to stress, including poverty, inadequate housing, and lack of adequate nutrition, all of which are more likely to impact families with low incomes, families of color, and immigrants. We recognize that the social determinants of health are a result of inequities in the distribution of power and resources, rooted in a history of racist local, state, and federal policies. By utilizing community health models, accelerating access to justice, and advocating for systems change—all based on families’ needs—DULCE strives to create a more equitable distribution of power and resources and address inequitable systems that preclude families from living healthy lives.

DULCE is currently located in 16 pediatric clinics across seven states, with partners across the health, legal, and early childhood sectors and plans to continue national expansion to connect more families to the support they need for their children to get a healthy start. If you are interested in learning more about DULCE, please click the tabs below or contact our experts.

What is DULCE? (For Spanish version, click here)

Approach Outcomes Resources DULCE Partner Portal

DULCE employs a strength-based approach to help parents navigate the challenges of caring for babies, raising healthy children, and advocating for what they need. We are transforming the way families experience the health care system, starting with their baby’s first routine medical visit. Families develop a relationship with a DULCE Family Specialist, who helps them navigate supports and creates the conditions for healthy development. By prioritizing parent-identified needs, connecting them to support, and building trusting relationships, parents get the support they need to raise healthy children and advocate for their well-being.

DULCE embodies a belief that all children and families should have the support they need for healthy development. The DULCE approach includes:

A community-based, early childhood organization. The organization guides the overall strategy and long-term planning for DULCE, coordinates care, and brings together the early childhood, health and legal experts to connect families with complementary resources and support.

Well-trained, supervised Family Specialists. A critical part of the primary care team, Family Specialists are trained in relational approaches to family-centered care and provide direct support, fostering a trusting relationship with families and building parents’ confidence.

A team that honors families’ needs and priorities. Parents know their families best. The DULCE Interdisciplinary Team reviews cases weekly, problem-solves together, and ensures families are connected to services by working with parents on what their families need most.

A legal partner. Integrating a legal partner into the DULCE Interdisciplinary Team helps children and families get the comprehensive services for which they qualify and improve the functioning of systems for the broader community.

Clinics located in communities that can benefit most. All families in the clinic are invited to participate in DULCE. This universal approach minimizes stigma and recognizes that all families need support during this first phase of their child’s life.

The model was co-developed by Robert Sege, M.D., Ph.D., now at Tufts Medical Center, and Samantha Morton, former CEO, MLPB. It is grounded in the compelling findings from a randomized controlled trial (RCT) conducted at Boston Medical Center in 2010-13. DULCE has a statistically significant impact on enrolled children and families, as well as the clinics that serve them. Results from the RCT published in Pediatrics in 2015 found that DULCE resulted in:

Accelerated access to concrete supports. DULCE families secured supports for which they were eligible at roughly twice the pace of control families.
Better completion rates for well-child visits and immunizations.
Reduced use of emergency room care by DULCE families.

As DULCE expands to more sites, more families will be connected to the support they need for their children to get a healthy start.

We Know DULCE Works:

100% of families offered choose to enroll and 79% of families complete DULCE.
65% of families receive all well-child visits on time, with DULCE implementation and CQI increasing this proportion by 50%.
70% of well-child visits occur with the DULCE Family Specialist present.
DULCE helps clinics implement highly reliable universal screening practices; 92% of families are screened for seven health-related social needs (HRSN).
- A 2023 study found that DULCE’s lighter-touch CQI approach can help clinics improve screening for seven HRSN, even when scaling DULCE to additional clinic sites. The study saw sustainment or improvements across most indicators, including on-time 1-month well-child visits and screening and resource referral rates for seven HRSN.
95% of DULCE families with concrete support needs receive resource referrals at time of positive screening results.
- The same 2023 study also found that 87% of families had used the resources they sought—and DULCE had offered—to address their HRSN.

Data from Arbour, et al. (2021) and Arbour, et al. (2023)

A 2022 article comparing DULCE families using traditional risk criteria (low-income, foster care, first-time parent, teen parent) used by targeted programs) found that

53% of DULCE families who did not meet traditional risk criteria had HRSN.
- Very few of these families were accessing resources at enrollment; half were connected to resources through DULCE.
72% of DULCE families with HRSN would have not been identified if risk-based enrollment criteria had been used.
Many of the families who were already utilizing HRSN resources before DULCE, including SNAP, WIC, and TANF, had unmet needs at DULCE enrollment.

Data from Arbour, et al. (2022)

Team members report that DULCE:

Improves relationships with families, who become more willing to disclose social and emotional needs through an integrated approach to screening and referral.
Develops and strengthens cross-sector partnerships between early childhood, health, and legal systems at multiple levels.
Leads to improved staff collaboration and quality of care at healthcare clinics with DULCE’s integrated approach to family-centered care.
Helps early childhood professionals better understand community needs and how to integrate resource information concerning social determinants of health into well-child visits.
Expands clinic capacity for holistic care and broadens opportunities to preventatively address families’ legal needs through the integrated medical-legal partnership.

Findings from Chapin Hall at the University of Chicago (2019)

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