Pediatric Practice Redesign

Client: Boston Medical Center
SERVICE SYSTEM DESIGN


How could pediatric care be reimagined as a family-centric practice?





 





Modern pediatrics developed over a century ago when infant mortality attracted the attention of pioneering doctors. Today, we see a new generation of pediatric pioneers, this time turning their attention from physical markers of well-being to social determinants of health. Pediatric practices are due a redesign to reflect this, to enable practitioners and families to focus not only on the health of the child, but on the family’s big picture.

Boston Medical Center (BMC) is New England’s largest safety net hospital, serving the region’s most vulnerable patients. BMC’s Center for the Urban Child and Healthy Family focuses on innovating the pediatric model of care to meet both the health and social needs of the children and families it serves.

We worked with this team to take a family-centered approach to redesigning the pediatric practice, focusing on making sure the children BMC cares for are school-ready upon entering kindergarten, leveraging the pediatric office as a key hub for connecting families to services during early childhood. BMC came to the program prepared to tackle its problem-solving framework from reactive to preventative, from siloed to networked behaviors, from child-centered to family-centered mindsets, and more.

Fourteen BMC families invited us into their homes for interviews. From talking softly with a new mom and her 2-week-old, to juggling and note-taking while playing with three boys under 7, we were able to bring forward truths from these parents and share their wisdom and expertise with the BMC team.

The solution that we co-created with families and the BMC team shapes the practice around supporting resilient family development. The focus on resilience builds skills to empower families beyond their health and strengthens the capacity to deal with trauma as the child grows. A family focus recognizes that families and caregivers grow along with their children. And a focused and relevant perspective on development focuses on the four key protective factors that support resilience and how these develop in early childhood (supportive adult relationship; self-efficacy and perceived control; adaptive skills and self-regulation; and sources of faith, hope and cultural traditions).

The Center for the Urban Child and Healthy Family began to pilot this new model of care in early 2020. Beginning with a cohort of 30-50 families with infants, the practice will initially focus on the Dorchester, Mattapan and Roxbury neighborhoods of Boston. The innovation team building this pilot has developed community partnerships to enable connected services beyond the hospital and rooted in families’ neighborhoods.


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