Addressing Social Health and Early Childhood Wellness Quality Improvement Project: The Wisconsin AAP Chapter Experience

Purpose/Objectives: Early life experiences impact childhood brain development. The majority of these experiences occur outside the medical practice environment. Pediatric medical practices can play a key role in building family resilience through identifying risk and protective factors, providing support through the therapeutic relationship, and connecting families to services when needed. The Wisconsin AAP Chapter was one of seven state AAP Chapters that participated in the Addressing Social Health and Early Childhood Wellness (ASHEW) quality improvement project. Our objective was to implement measurable process improvements for addressing perinatal depression, social-emotional development, and social determinants of health.

Design/Methods: This 11-month (July 2020-June 2021) quality improvement learning collaborative utilized the Institute for Healthcare Improvement’s Model for Breakthrough Improvement with monthly webinars, Plan-Do-Study-Act (PDSA) cycles, and monthly data reviews. Teaching and co-learning happened at both the state and national level. Training and leadership support were provided through the national AAP. 10 measures were reported on monthly by practices (documentation of family strengths/protective factors, perinatal depression screening/discussion/referral, social determinants of health screening/discussion/referral, social-emotional screening/discussion/referral), with a focus on well child checks from 6 months to 5 years of age. Each practice was also required to engage a family advisor who provided guidance and expertise on family-centered approaches as the practices engaged in practice level change and systems transformation.

Results: In Wisconsin, a total of 8 practices participated throughout the state including pediatric and family medicine (total of 25 providers, 19 clinical staff). 10 webinars were held that featured topics such as: family-centered care, structural racism, family strengths and protective factors, improving office environments, supporting families with complex needs, referrals & tracking, and community referral networks. Practices reached the 90% goal for 8 of the 10 measures at project end (Figures 1 and 2). The largest increases from project start to end were seen in documentation of family strengths/protective factors, screening for perinatal depression, screening for social determinants of health, and discussion of social determinants of health. At project end, all practices were consistently discussing screening results for all 3 screening types. Documentation of family strengths/protective factors was an initial challenge in part due to the lack of a formalized screen. However, this improved with webinars and co-learning. All 8 practices engaged family advisors, many for the first time. Several of our practices decided to start with perinatal depression screening and/or social determinants of health screening rather than social-emotional screening which explains the lower screening rates.

Conclusion/Discussion: A statewide quality improvement project with national support and co-learning opportunities led to practice level changes around family-centered approaches and referrals for young children and families during a global pandemic. Practices will now continue to work on sustainability of changes achieved including ongoing engagement with family advisors.