A few months ago, I highlighted the biological science around toxic stress and its impact on child well-being. Now the antidote to toxic stress has been published as a new policy statement (10.1542/peds.2021-052582) co-authored by Drs. Andrew Gardner and Michael Yogman. Pediatricians are now called upon to use the Family Centered Pediatric Medical Home (FCPMH) to support nurturing relationships, reduce external sources of stress on families, and strengthen core skills of families to support well-regulated nurturing environments. The science behind these recommendations is solid (read the policy statement for details). The benefits of raising children in homes and communities with safe and secure nurturing relationships are well-known and evidence-based. And we know that pediatricians play a significant role as trusted advisors to families and communities with regards to child health. But how do you implement these recommendations and strategies in a busy pediatric practice with 15-20 minutes per patient?
For years there have been calls to “transform” pediatric practices and create FCPMH’s that address the bio-psycho-social needs of children and families. The American Academy of Pediatrics even has a website dedicated to helping practices meet the challenges of the ever-changing health care environment. But if we truly want to create practices that promote flourishing and child well-being, we are going to need to be more radical with our care delivery systems, payment systems, and approach to pediatric primary care. Hopefully pediatricians can lead those discussion and begin to move the entire system away from a fee-for-service approach that does not value relational care to one that incentivizes spending time with families to help them create safe and nurturing environments for children. But until that time, the policy statement has some suggestions of approaches you can take to begin the process in our current system:
- Foster strong, trusted, respectful, and supportive relationships with patients and their families
- Foster strong, trusted, respectful, and collaborative relationships with community organizations
- Embrace a vertically integrated public health approach to promote relational health that is founded on universal primary preventions (such as positive parenting programs, Reach Out and Read, and developmentally appropriate play)
- Become hubs for medical neighborhoods, horizontally integrating a wide array of local efforts to work towards improving the health of the community you work in, such as partnering with community health workers or hosting legal aid in your office
- Advocate that health systems, payers, and policy makers at all levels of government align incentives and provide funding to promote the universal primary prevention efforts needed to create safe and nurturing environments for children
We have a long way to go, but all of us should see this policy statement as a call to action to create practices and communities that support families and the nurturing of early brain development for all children.