Early childhood advocates turn to pediatrician’s office as key hub for screening kids and helping parents
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“What’s extremely powerful about pediatrics is it’s the one place that all parents in America go with their babies,” pediatrician Dr. Jonathan Goldfinger said recently. “There’s almost nowhere else that you can connect with families so consistently.”
Goldfinger is the chief medical officer for HealthySteps, a national program that seeks to embed specialists in pediatricians’ offices with the goal of fostering secure relationships between parents and children, especially from birth through age three. The program also strives to screen children — and parents — for potential disorders early and connect families to specialists in the community when needed.
The social and emotional health of children is inextricably linked with that of their caregivers, Goldfinger said, speaking recently at a forum on maternal mental health in Los Angeles. There has been a growing awareness in recent years that children can be negatively impacted in utero and beyond if a mother has an untreated mental illness.
The pediatrician’s comments came shortly after California Data Fellow Jocelyn Wiener’s scathing report in The Sacramento Bee on California’s dismal rates of screening low-income children for developmental issues.
Despite wide consensus on the importance of screening young children — and a federal mandate to do so — Wiener discovered that “in 2016, less than 21 percent of California parents reported that their young children’s health care providers had them complete a standardized developmental screening tool.” And Wiener found that even in the top performing states, “less than half of parents reported their children had been screened.”
Goldfinger and the HealthySteps model — run by the umbrella organization Zero to Three — is hoping to change that. He says the specialists in the pediatrician’s office do not have to be psychologists, psychiatrists or even social workers. He says marriage and family therapists, occupational therapists or other practitioners could step into the role of providing extra support.
Pediatricians often have little time — and little training — to address the non-physical development of the child, let alone delve into the parents’ mental and emotional health, Goldfinger said.
“Pediatricians are trained to do a number of these things to a degree,” he said. “But they lack training to take them to the next step that is necessary and can make the difference in whether a family can connect to a resource.”
The HealthySteps model echoes the so-called patient-centered medical home, championed by the Affordable Care Act, in which the primary care physician serves as the hub, coordinating a team of people who care for the patient. The model advocated by Goldfinger is specific to the first three years of life, and takes into account both the child and the caregiver, he said.
“The relationship between the parent and child is so critical to brain development and the parents’ ability to buffer the child from early adversity or toxic stress,” Goldfinger said. “We’re thinking of supporting new parents and connecting them with resources and also guiding them and being there for them during that very challenging time in life.”
The specialists working with the pediatrician, he says, can also help parents not only flag potential problems, but also identify normal issues that may arise between parents and children.
“We know that there are temperament mismatches between children and their parents, and that’s actually very common,” he said. “We shouldn’t think that the mother or the father or other caregiver who struggles and feels the child is difficult is anything but just a mismatch.”
"The relationship between the parent and child is so critical to brain development and the parents’ ability to buffer the child from early adversity or toxic stress. We’re thinking of supporting new parents and connecting them with resources and also guiding them and being there for them during that very challenging time in life." —Dr. Jonathan Goldfinger
By identifying these so-called mismatches early on, a therapist, for instance, can teach parents ways to cope with parenting challenges, which in turn could help build stronger bonds between parent and child. Many scientists believe those bonds lead to a healthier more well-adjusted child.
Goldfinger isn’t the only one trying to use the pediatrician’s office as a hub. Dr. Nadine Harris Burke has been pushing to get ACEs screenings — a measurement for childhood trauma — into all pediatric visits. And, a recent study made the case for screening mothers for postpartum mood disorders when they bring their children to pediatric primary care.
While all these may sound like worthwhile and necessary services to offer parents and children, they come at a cost.
Wiener’s reporting found that the biggest barriers to increasing the number of developmental screenings were time and money. Experts told her that Medi-Cal, California health insurance program for low-income residents, “pays so little and office visits are so brief that pediatricians tend to prioritize physical examinations and immunizations over developmental screenings.”
Wiener’s reporting also revealed yet another barrier to getting more kids screened: access to specialists. One woman told Wiener that she had to take several days off work to drive her child to the nearest pediatric gastrointestinal specialist covered by the family’s insurance, 90 miles away.
Goldfinger argues adding services to the pediatrician visit actually saves money in the long run, despite low – or zero – reimbursements for many early childhood outcomes. He said the task is to convince insurers that investing in children’s social and emotional health and the parent-child relationships is ultimately good for their bottom line.
“We know that we’re saving you money with these types of services, there’s really no question about it,” he said. “Study after study after study has shown that these types of supports — whether it’s breastfeeding, mental health, infant and early childhood mental health, for parents — these types of teams still save you money, even if you have to get added professionals involved, the long-term gains financially are there.”
[Photo: Jason Connolly/AFP/Getty Images]