In partnership with primary care and our families, the Center for the Urban Child and Healthy Family (CUCHF) developed a new care model—the Pediatric Practice of the Future—that ensures all children are healthy and ready to learn, with adequate support to thrive, by five years old. The care model was developed using Human Centered Design methods, highlighting families’ goals and priorities for their health care.
In January 2020, CUCHF launched the pilot of the Practice of the Future clinic, embedded within pediatrics primary care at Boston Medical Center. An “innovation team,” including a pediatrician, an infant mental health social worker, a community wellness advocate, financial coach and a nurse run a Wednesday afternoon clinic for families from the primary care practice. The innovation team strives to build an equitable health system that fosters families’ self-efficacy and autonomy and promotes social and racial justice. As an aspect of this work, the Center partnered with the Boston Public Health Commission to conduct a tailored training curricula for our innovation, evaluation and project team on: Trauma Informed Care & Resilience; Racial Justice & Health Equity; and Stress & Vicarious Trauma.
Core elements within the Practice of the Future include a focus on economic well-being, family eco-mapping, family wellness plans and pre-visit planning. The importance of health care supporting economic well-being was lifted up by families during the human centered design process as a fundamental way that health care could support them. Lucy Marcil, MD, associate director of economic mobility, is leading this work by designing a menu of financial services, such as tax preparation and opening child savings accounts, which are systematically offered to families in the Practice of the Future pilot. Additionally, Marcil has recently been awarded a grant from the ASPEN Foundation to embed a full-time financial coach within the team. Family ecomapping is conducted by our social worker, and is a means to understand the greater environment in which the child and family are living (for example, social networks, community connections), the areas in which they are thriving and the areas in which they would like support. This process is used to inform a comprehensive family wellness plan that outlines families’ goals for the next six months, including priorities for financial well-being. Finally, our community wellness advocate connects with families prior to their visits to ensure their time at BMC is organized around their priorities.
Core to the effectiveness of the Practice of the Future model is its ability to be scaled and sustained beyond the pilot program. As such, the Center, with support from the Center for Healthcare Strategies and the Robert Wood Johnson Foundation, has entered into a partnership with BMC HealthNet Plan to identify a payment model that supports the right “dose” of access to a variety of flexible health care services including behavioral health, community support and telemedicine, and to test new quality metrics that better relate to child and family well-being. Currently the Center is refining new quality metrics related to dyadic care, health equity, economic mobility and school readiness that could be administered within the clinical setting.
As of November 1, the Practice of the Future has recruited 46 families of 92 children ranging in age from birth to 16 years old. The goal is to recruit up to 100 families within the first year. As a core part of the pilot, we are testing the impact of the new model on health and wellness, and iterating and refining components of the model. We also are exploring the best ways to bring this model to scale.