Child Poverty Interventions in the US
Redesigning Health Care Practices to Address Childhood Poverty

https://doi.org/10.1016/j.acap.2016.01.004Get rights and content

Abstract

Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty.

Section snippets

Strategies for Practice Redesign to Address Child Poverty

The high prevalence and wide distribution of child poverty suggest that many, if not most, providers of pediatric health care in the United States are seeing some children in their practices who are poor or near poor. Hence, it is important for all child health providers to consider how their individual practices might transform in order to address the social determinants of health that affect poor children and their families. This transformation will require the development and implementation

Embedding Programs Within the Practice

Many practices serving larger numbers of poor families have considered how to provide higher intensity, on-site interventions to address social determinants of health. Some practices, particularly those that are hospital based or within larger multispecialty groups, have access to the traditional model of on-site professional social work staff, case workers, and care coordinators to support some of the effort of identifying resources, connecting families, and tracking their progress toward

Financing to Support Practice Redesign and Provider Effort

In order to establish effective screening processes to address child poverty, embed poverty-related programs into a practice, and provide care coordination and effective communication with community partners, these activities must be reimbursed appropriately through health care financing structures. Although the National Committee for Quality Assurance patient-centered medical home standards embrace the concept of care coordination, support in the form of payment to providers for efforts to

Summary and Conclusion

Child poverty is highly prevalent and widespread in the United States and has a substantial negative impact on child health and well-being. The negative impact extends into adulthood, with resultant consequences to individual adult health, health care costs, and society at large. Pediatric health care providers and their national organizations are increasingly focused on working to prevent and mitigate the effects of poverty. Although the details of when and how often to screen are not well

Acknowledgments

We thank the following for their participation and contributions to the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty: Kelly Hall; David M. Keller, MD; Marjorie S. Rosenthal, MD, MPH; Anita Shah, DO; Roy Wade, MD; and H. Shonna Yin, MD, MS. Received for publication October 6, 2015; accepted January 5, 2016.

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    Dr Klass serves as national medical director for Reach Out and Read, for which she receives no compensation. The other authors declare that they have no conflict of interest.

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