The recent RAPID National Pediatric Clinician Survey findings offer a snapshot of what pediatric clinicians are seeing among families with young children across the country.
Based on responses from 1,010 clinicians caring for children under age 6, the report highlights three challenges:
- Families are struggling to access critical health services and resources. One in five clinicians reported that families were unable to access the developmental and behavioral health services they had been referred to. Clinicians identified several contributing barriers, including a shortage of available providers due to a devaluation of the pediatric specialty and lower lifetime earnings, insufficient or nonexistent insurance or coverage, complex health systems that are hard to navigate, and transportation.
- Clinicians are seeing growing challenges around vaccine confidence and trust. 96% of surveyed clinicians reported that parents were at least sometimes misinformed about vaccines, and 84% said they were seeing more questions or concerns about vaccine safety than a year ago. Clinicians also reported that families are getting vaccine information from many sources, including not just health care providers, but often social media and ChatGPT. More than three-quarters said vaccine hesitancy had affected their clinical practice and or trust with the families they work with.
- Families are struggling to afford basic needs. More than half of clinicians said hunger or food access challenges and difficulty paying for utilities had become more common over the past year, while nearly half reported that housing instability had increased. Nearly half also reported that families’ access to federal safety-net programs had decreased, with SNAP, Medicaid/CHIP, WIC, Head Start, and child care subsidies among the programs families were having the most difficulty accessing.
Johanna Lister, J.D., M.P.H., Policy Director at the HealthySteps National Office, weighs in on the implications of these findings:
Together, these findings show how interconnected the challenges facing young children and families have become. Pediatric clinicians are increasingly being asked to help families navigate not only health care, but also the systems and circumstances that shape whether children can access care and thrive.
These findings are deeply troubling but not surprising.
They reinforce what pediatric practices across the HealthySteps network see every day. Families are navigating multiple threats to their stability while access to critical supports such as SNAP, Medicaid and CHIP, and WIC are becoming more difficult.
This report is an important reminder that we cannot separate a child’s health and development from the conditions in which they live. When families struggle to afford food, child care, and lose access to housing assistance and health coverage, clinicians can see the consequences: increased hunger, too few diapers, and heightened family stress, to name a few. The reality of the intersection between these issues and a child’s health is that many clinicians have found themselves not just providing medical care during visits but also helping families navigate complex, siloed, and underfunded resources and programs. As safety-net programs are cut and economic hardship rises, the need for additional support and guidance will only increase, as will the burden on pediatricians already stretched thin.
This is where the HealthySteps model makes a difference.
HealthySteps Specialists help pediatric practices expand their capacity to address the many issues affecting a baby’s health. When a family shares concerns about food insecurity, housing instability, loss of benefits, or difficulty accessing services, HealthySteps Specialists can help navigate systems, connect families to community resources, and reduce the burden of managing complex bureaucratic processes alone.
But the HealthySteps model was designed to complement a strong safety net, not replace one. The hardships and barriers that families are facing are not inevitable; they are the result of policy choices.
Recent federal cuts to already under-resourced safety net programs are having real and negative impacts on babies and their families. As the safety net erodes and communities strive to do more with less, HealthySteps Specialists are increasingly stepping up to fill gaps, but remain limited without broader change and support. A HealthySteps Specialist can help a family navigate a shortage of available providers, but cannot create a provider where none exists. They can help a family apply for benefits, but not if the family no longer qualifies. And they can connect families to resources, but cannot replace the resources themselves.
So how can we support our pediatric care system during a time when they are being asked to respond to ever-growing challenges? The RAPID findings point to a clear need for policy changes and solutions that strengthen pediatric practices while also addressing the gaps and shortcomings of the surrounding systems.
First, policymakers must protect and strengthen the safety-net programs that support children’s health, development, and school readiness.
We are moving in the wrong direction. The United States had made great strides to reduce the number of uninsured children and are now seeing those numbers rise. These programs are foundational investments in healthy children and family well-being; they are necessary for giving every baby a chance to thrive.
Advocacy plays a critical role in protecting these programs and helping Congressmembers understand the impacts of their policy on families and the clinicians who serve them. Many of the elected officials who are making these decisions have no experience working in health care, childhood development, or raising a child under financial distress. They may spend all day looking at data that should prove the weight and scope of their policies but often it’s the stories of real people that help policy makers understand what those numbers mean for people. This is why it’s crucial that decision makers hear from families and pediatric clinicians who bring firsthand knowledge and lived experience of what it looks like when families lose access to supports and resources.
Second, administrative barriers that prevent eligible families from receiving support should be reduced through streamlined enrollment and renewal processes, continuous eligibility policies, and greater coordination across programs.
Finally, policymakers must support the pediatric primary care teams that are supporting families. The clinicians reporting these challenges are working within systems strained by workforce shortages, increasing complexity, and resource limitations.
Families are telling us what they need, and clinicians are sounding the alarm. If policies don’t change, children around the country will suffer, and pediatric primary care won’t have the capacity to keep up with growing critical needs.