Addressing Social Health and Early Childhood Wellness (ASHEW): A National Learning Collaborative to Foster Family Resilience

Purpose/Objectives: Unmet social needs in early childhood create risk of lifelong physical/mental health challenges. Pediatricians can intervene by routinely assessing child development including child and family social emotional wellbeing using an early relational health approach that fosters family resilience. Many providers report barriers to screening including a lack of appropriate referral resources and interventions and inadequate payment structures. The Addressing Social Health and Early Childhood Wellness (ASHEW) learning collaborative's goal was to test a national strategy to increase social needs assessment, family-centered discussion, referral/linkage, and follow-up with families at 90% of 0-5 years well child checks (WCC).

Design/Methods: The American Academy of Pediatrics (AAP) conducted an 11-month quality improvement (QI) virtual learning collaborative using the Model for Improvement to address social needs (Figure 1). Seven AAP chapters, supported by AAP, provided 66 primary care practices monthly education/collaboration, data review, and coaching. Practice teams included a physician leader, staff, administrative support, and family advisor.

Practices conducted monthly chart reviews (N=40) following 6-month WCC for perinatal depression (PD), and following 6, 15, 24, and 48-month WCC for social drivers of health (SDOH) and social emotional development (SED). Chart reviews assessed (yes/no) documentation of screening, discussion, and referral/linkage. Improvements from baseline were examined using run charts.
Practice transformation strategies included family engagement during WCCs, embedded family advisors on practice QI teams, strengthened community partnerships, and enhanced support from AAP chapter family advisors. Quarterly qualitative surveys further assessed practice transformation on trauma and resilience informed care, family-centered approaches, and care to advance race and ethnic equity.

Results: Chart review data shows nonrandom variation in 8 of 10 measures or a shift of 6 consecutive points above the median (Figure 2). Family strengths started low and improved (31.1% to 59.2%). PD started high and improved close to goal PD Screening (67.7% to 86.2%), Discussion (46.2% to 80.2%). SDOH started low and increased greatly SDOH Assessment (26.3% to 60.1%), SDOH Discussion (48.5% to 81.9%), and SDOH Referral. SED started low and remained low Screening (31.2% to 40.7%), Discussion (82.9% to 87.6%), and Referral (77% to 73.8%). The March 2021 quarterly narrative survey reported 16% (n=10) of practices were not yet implementing SDOH assessments and 34% (n=17) were not yet implementing SED screening. Post project qualitative survey results will be available in early fall.

Conclusion/Discussion: Pediatric providers can make quality improvements to address unmet social needs using an early relational health approach to foster family resilience. Next steps include continued progress toward QI goals during a second phase and enhanced training resources shared with all pediatric providers to increase rates of screening, discussion, referral/linkage, and ascertaining outcomes from families.