(Boston) – Nov. 3, 2017 – More than a quarter of children in Boston live in poverty. Children living in poverty bring a unique set of issues to their health care providers. These include housing instability, food insecurity and exposure to violence – all of which can have negative short and long-term health implications for children and families.  

Providing excellent care for these families requires developing innovative clinical programs to ensure that families have access to the resources they need.  It also requires going beyond the walls of the doctor’s office and into the community, and building partnerships between health care providers, educators and community organizations. 

The department of pediatrics at Boston Medical Center (BMC) is seeking to revolutionize care for urban families, forming a center aimed at ensuring that all children and families – regardless of their zip code – have an equal opportunity to be healthy and successful. The Center for the Urban Child and Healthy Family aims to develop and test innovative models of care for vulnerable families, strengthen partnerships with community organizations focused on children and families, and disseminate best-practice, evidence-based care models to practitioners, policy makers and researchers across the country.  The center, directed by Megan Bair-Merritt, MD and Melissa Gillooly, will focus on the following three areas: trauma informed care, bi-generational (parent-child) programming, and care of children with chronic conditions.

One of the first center-funded pilot programs, Supporting Our Families through Addiction and Recovery (SO FAR) is based in pediatric primary care and led by Eileen Costello, MD.  The weekly clinic provides – in the same visit – care for mothers with substance use disorder and their newborn infants, providing continuity of care and ongoing support for families during the postpartum period. The clinic includes medical care, peer support counselors as well as psychosocial support services.

Another pilot program is a clinic for children with special needs who have individualized education plans.  Families are seen by Soukaina Adolphe, MD, the pediatrician leading the clinic, and Ivys Fernandez-Pastrana, an attorney and family navigator.  Together, they work with families and schools to ensure that children are receiving the necessary accommodations at their school to help them thrive.

Low-income children may be less prepared for school than their wealthier counterparts. To address this disparity, the SMART (Schools and Medicine Advancing Readiness Together) program will unite families, medical providers and educators to develop individualized success plans for pre-K students, integrating their medical, educational and social needs. 

In addition, the center has created a two-year fellowship focused on teaching the next generation of pediatric leaders about advocacy, policy and program evaluation. The first fellow is Lucy Marcil, MD, MPH, who, in collaboration with Michael Hole, MD, MBA, developed StreetCred, a free tax preparation service that BMC patients and staff use to file their taxes for free to ensure that they receive the tax benefits and credits they are entitled to. Since its founding in 2015, StreetCred has returned more than $1M in tax refunds to patients, staff and their families.

“Past and present, pediatricians from BMC have developed innovative approaches that have helped revolutionize how we care for vulnerable patients,” said Bob Vinci, MD, chief of pediatrics. “This center will be a forum for innovation, allowing us to build and expand care advances so that more children and families can achieve better health outcomes.” 

Programs like the Medical Legal Partnership, which brings legal assistance into the health care setting for families in need, was developed at BMC and is now in place at nearly 300 health care institutions in 41 states across the country and has served more than 75K families (2015).  In addition, Reach Out and Read, founded at Boston City Hospital (now BMC), incorporates books into pediatric care to promote literacy, serving 4.7M children each year in all 50 states.

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