The covid-19 pandemic has forced us to reevaluate how we deliver care to our patients. How do we balance Shelter in Place orders with the need to provide well child care and vaccines? We work in an FQHC and serve a largely immigrant Hispanic community, many of our patients' parents are migrant and seasonal farmworkers. We made many changes in our clinic to adapt to covid-19: an outdoor respiratory clinic and covid testing, telephone and telehealth visits to keep patients who are sick out of clinic, telephone outreach to address social determinants of health (mainly food insecurity and housing), administering of free medications for those uninsured patients who could no longer afford their medications. Throughout these changes to address immediate needs, we limited our well child visits to 2 years and under to protect our patients, our staff and our limited clinic resources. However, as we settled into this "new normal", we quickly realized we needed a recovery plan to address the backlog of well child visits for all ages and vaccines that could be nimble enough to withstand possibly repeated rounds of social distancing over the months to come. That is how the hybrid clinic model came into fruition. Our pediatrics team was committed to keeping our patients immunized and to support their growth and development during covid-19. We began reaching out to colleagues across the state and country to find out what others were doing, joined one of the AAP Covid-19 ECHO groups and researching emerging best practices for how to deliver well child care during a pandemic. We brought the model to our Covid-19 incident command team and to our frontline medical providers for feedback and ideas. Our current well child check model is in pilot stage and involves a combination of telephone and in person components. We are learning and innovating how to best serve our patients. As a Level 3 Patient Centered Medical Home and a Federally Qualified Health Center, we already do quality improvement and quality assurance tracking on many topics, including vaccines and well child visit adherence. We will continue to use data to monitor our success with this model and make adjustments along the way as needed. The covid-19 pandemic is a global challenge affecting us all. Technology, specifically telephone and telehealth services have allowed us to innovate quickly on how to deliver care-both acute and preventive- to vulnerable populations. This time in history is highlighting the advances of hospital and ICU medicine to treat people suffering a new disease and, at the same time, it puts primary care into sharp focus as a critical safety net that must remain intact, even during a pandemic, to support our children.

An initial overview to train medical providers on how we will approach well child visits in clinic during shelter in place orders related to covid-19.

Summary of Well Child Visits Table depicting how telephone technology will be used to limit the amount of time the patient is physically in clinic while attempting to maximize adherence to Bright Futures