Early Childhood Integrated Behavioral Health: A Promoter of Equity in Pediatric Care
Early Childhood Integrated Behavioral Health: A Promoter of Equity in Pediatric Care
This review utilizes the HealthySteps model to exemplify how specific components of early childhood pediatric primary care behavioral health services are integrated into one evidence-based model that serves to mitigate health inequities.
Abstract
Objective: This topical review examines an equity-focused parenting intervention and how it addresses structural problems in health care that perpetuate inequities for marginalized groups.
Methods: Four domains of pediatric primary care (PPC) that perpetuate health inequities are discussed, including (a) acontextual, individual patient focus of health care; (b) fragmented and siloed networks of care; (c) limited cultural awareness in care; and (d) diagnosis-driven health care benefits. Next, a model of two-generational primary care behavioral health is discussed as a way to mitigate structural aspects of PPC that contribute to inequities.
Results: Integrating early childhood behavioral health into PPC, a system designed to provide universal prevention and health promotion, can enact a transformative impact on a traditionally racist system of health care. The following specific mechanisms of this model are discussed: (a) expanding the acontextual, individual patient focus; (b) providing care coordination that mitigates fragmented and siloed networks of care; (c) engaging in reflective practice to enhance cultural awareness in care; and (d) shifting from diagnosis-driven to family-centered paradigms. Conclusions: Implications for practice, clinic transformation, and systems-related policy changes that can shift structural policies that perpetuate racism and oppression are discussed.
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