055 - Building Trust in Early Childhood Development and Health Systems: Identifying Key Determinants for a System that Supports Families

Publication Number: 55.4102

Caroline D. Wator, American Academy of Pediatrics, Chicago, IL, United States; Kendall A. McElroy, Early Childhood Developmental Health Systems: Evidence to Impact Center, New York, NY, United States; Anthony Murphy, University of Birmingham, Birmingham, England, United Kingdom; Nnenna Thompson, Georgetown University School of Medicine, Rockville, MD, United States

Background: Early childhood developmental health systems (ECDHS) are essential for supporting the physical and socio-emotional growth of children aged zero to five. These systems are especially vital since one in six children experience a developmental delay. Unfortunately, inequities and structural barriers hinder many families from accessing essential services. For instance, only 53% of children referred to Part C services were ultimately enrolled, highlighting the need for improvements within the care continuum.

Objective: As part of a larger ECDHS advancement project, the team sought to identify the facilitators and barriers to implementing a strong ECDHS at the primary care practice and state level.

Design/Methods: Institutional IRB was acquired for this project. Two focus groups were conducted with a total of nine pediatricians, including general pediatricians (n=6) and behavioral developmental pediatricians (n= 3). A focus group was also conducted with Early Childhood Champions who are leaders in advancing early childhood priorities in their states (n=2). Additionally, five interviews were conducted with key informant pediatricians that serve in national roles to advance early childhood health systems. The transcripts were coded using Inductive Thematic Analysis.

Results: Several determinants emerged from the data: relationship building, early relational health as a philosophical stance, attuning to families, and reflective practice were emphasized by pediatricians as facilitators to ECDHS service delivery. Whereas, constraints relating to resource allocation, workforce issues, and the biomedical model as a philosophical stance dictating provision, were discussed as barriers.

Conclusion(s): Providers identify perceived trust between families and services as crucial for building a robust ECDHS. Barriers such as limited visit times, lack of provider and service continuity, and historical oppression can undermine trust and simultaneously reduce the effectiveness of early childhood systems. To overcome these challenges, it is essential to focus on practice-level facilitators that foster relationships. The bio-medical bases of healthcare, and its impact on preventative services, also consistently emerged. Some pediatricians linked this to current payment structures such as the fee-for-service model which can be inflexible for billing. Thus, addressing system-wide issues, like payment structures and policies that support early childhood services, should be prioritized to enhance the overall family experience and promote healthy development for all children.

Commonly Described Barriers and Facilitators to ECDHS


Commonly Described Barriers and Facilitators to ECDHS