Dr. Megan Bair-Merritt discusses the BMC Center for the Urban Child and Healthy Family, how it helps families in urban areas, and why BMC hopes it will be a model for other healthcare organizations to implement.
Megan Bair-Merritt, MD
As a pediatrician and child health services researcher Megan Bair-Merritt, MD has conducted social epidemiology and intervention research for over 10 years, spanning her tenure as an Academic General Pediatrics fellow through her current role as an Associate Professor of Pediatrics and Associate Division Chief of General Pediatrics. Learn more about Megan Bair-Merritt, MD
Melanie Cole (Host): Boston Medical Center established the Center for the Urban Child and Healthy Family with a goal to improve and advance medical care for its urban families. My guest today is Dr. Megan Bair-Merritt. She’s a pediatrician and child health services researcher and she’s the director for the BMC Pediatric Center for the Urban Child and Health Families, all with Boston Medical Center. Dr. Bair-Merritt, tell us what is the Center for Urban Child and Healthy Family and how did it come about?
Dr. Megan Bair-Merritt (Guest): Thank you Melanie. The Center for the Urban Child and Health Family was launched in 2016, so we’re about three years old, really with a vision of health equity. Our mission is that every child has an equal opportunity to achieve his or her full potential, and we think about achieving that goal through fundamental redesign of the care that we deliver to families facing adversity. So how do we through BMC Primary Care really better meet the needs of our families?
Host: BMC has long recognized that an individual’s economic status, education level, access to good schools, security housing, food, and so much more can impact health. Tell us what you know about how these kinds of things and these insecurities can impact a child and the whole family’s health.
Dr. Bair-Merritt: Yeah, it’s a great question. We know that the things that you mentioned, which we call the social determinant of health have profound impact on children’s health and probably actually have more impact and are more prevalent than many of the things than we sort of commonly think about, pelvic infectious disease, these are equally as important. When children are raised in poverty, they have higher rates of many both acute and chronic diseases and when you look at pediatric medical care, most of the care that we deliver is actually based on a schedule that was set hundreds of years ago, and when infectious disease was really what was most impacting kids’ health and so we tend to see children for example, around an immunization schedule, which is critical, but we know that the content of well child visits does not always best meet the needs of families who are dealing with these issues. So part of what we are about is how do we really fundamentally redesign that care to place priority on some of these issues that families are facing and that has tremendous impact. I think the other thing that I would say is that we know that for young children, the period between birth and 3 years is an incredibly sensitive one. So if you think about when a baby is born, they don’t do a whole lot. They kind of eat and sleep and cry, and by the time they’re 3, they are walking, they are talking, they’re sort of little human beings that are really interacting with the world and what is happening is tremendous brain growth. So when children are exposed to social detriments of health, there’s the potential that it really effects their long term health, so we view them at the times that interventions might be particularly important.
Host: And interventions are particularly important at that time, but how are you reaching out to these families? What approach are you using because I would think some of them would be resistant to come to a center or even know about it?
Dr. Bair-Merritt: It’s a great question. So there has been programs designed to, for example, promote social and emotional health within primary care. Our goal though is to really at the outset, think about exactly what you are saying, about what would make families resistant to doing this? What do they actually want from their care? And so we are using a process called human centered design, and so the idea of human centered design is that it puts – it comes from business, and it’s the idea that it puts the end users or the consumers from the business world, kind of in the co-creation process from the beginning, and so we are in the process now where we have – are working with a nonprofit organization called Agency that’s a human designed firm, and they are doing deep ethnographic work with our families who have volunteered to really talk about what they would like, what would be helpful for them, how can their pediatric care model better serve them, better connect them with community resources. And then families who are willing will continue with us through the co-creation process of what this model looks like, and so our hope is by involving our families from the very beginning and through the creation of this, what we’re calling the pediatric practice of the future, it will be designed from the outset to be something that’s really meaningful.
Host: Tell us about some of the unique and specific grant funded programs that are run through the center in regards to addiction or special needs, low income, teaching, even the medical/legal partnership.
Dr. Bair-Merritt: Yeah so we are really interested in thinking about how to do pediatric health care differently, and so we put out calls for grants from our own faculty to think about really again how to deliver care in a different way to our families, and funded two clinics that I think are really important. The first one is the SOFTAR Clinic, or Supporting Our Families Through Addiction and Recovery, and that clinic serves new mothers with substance abuse disorder in their infant and the hope is to create, and what the team does amazingly, is creating a trauma informed, non-judgmental space where infants can receive their care and moms also can receive care as well; so the infants and moms are able to be seen together, and that concerns about 100 mother/infant dyads and it’s just growing amazingly, and has had some profound connections with our families that have said it’s been really helpful. The second clinic that we funded is an IEP or Individualized Education Plan Clinic and the idea there is that many of the children that we serve have individualized education plans at school, but it’s hard for pediatricians to connect with schools to really advocate for the best educational services for their families, so this is a clinic that’s embedded within our primary care clinic, such that if a child either has an existing individualized education plan or the parent or provider has concerns that the child may need one, they can go to this clinic. The clinic is run by one of our primary care pediatricians who has developmental pediatric training and our head of family navigation, who is an attorney, and they work very closely with the school system to ensure that the child’s plan really matches their learning needs. So with both, I think with the SOFTAR clinic, we’re really learning about providing care to parents and to children in the same space, and with the IEP Clinic we’re really learning about how to make deeper connections with schools.
Host: What type of providers are available and involved in this project and while you’re answering that, tell us how the community is involved?
Dr. Bair-Merritt: Yeah so we – we are in the phase now where we are really building what we call the pediatric practice of the future, and we have a leadership team that involves members of the primary care team, including it’s medical director, Eileen Costello, some of its pediatric providers, the head of nursing, the head of operations, and we’ll be doing similar interviews with providers and staff about the type of care that they would like to be able to offer to their families and what the pediatric practice of the future might look like. With regard to community organizations, we have made many good connections with early childhood education programs and our thinking about how to best ensure that our families know about high quality early education spots in their neighborhood, and how we can best work with them to do those applications if they are interested. We also have a partnership that’s funded by the Boston Foundation with a group called Economic Mobility Pathways. Economic Mobility Pathways, or Empath, is a national program that’s actually based in Boston that trains people in what they call mobility mentoring, which allows them to have financial literacy and do problem solving around their own financial mobility, and we have build a partnership to consider what it would look like if some of our community health workers or navigators were trained in mobility mentoring so that we could offer that to our families.
Host: Doctor, is it a separate center, and if it’s not, where is it housed?
Dr. Bair-Merritt: So we are a virtual center. We are within the Department of Pediatrics. So within the Department of Pediatrics we are starting with our focus in pediatric primary care and thinking about building the practice of the future within our current pediatric primary care setting.
Host: What’s the hope that this will someday become a national model for other healthcare organizations to implement because I really see that other healthcare organizations would look at this and say that’s really a great way to reach out to the communities, and while you’re answering that, tell us about your ongoing vision for the center.
Dr. Bair-Merritt: Yeah, our ongoing vision for sure is that we will be able to create a national model, and so as we’re doing this development process of the pediatric practice of the future, we’re thinking very specifically about scale and spread, and in particular we realize that everything is sort of not one size fits all for all pediatric practices across the country, but it’s our hope to really delineate what are the core components of the model that families say is really important to them, and which parts are adaptable based on setting. So creating a model that’s flexible enough that it’s able to be scaled, but it also contains core components that we learn from our families and providers are really essential in innovating care.
Host: What else would you like to add? What would you like the listeners to know about the Center for Urban Child and Healthy Family, how they can get involved? Just give us your best information and hope for the future.
Dr. Bair-Merritt: So we have put our steak in the ground that by 2028 every child seeking care at Boston Medical Center Pediatrics is healthy and ready to learn by 5. So we’re very committed in the next, I guess we’re down to 9 years now that it’s 2019, having this pediatric practice of the future in place and really gathering data and assuring that the families that we see when children arrive at kindergarten, they’re able to arrive healthy and ready to learn. We’re committed. We sort of realize that doing that requires fundamental systems change, and so I think it takes a village. Folks who are listening, who are interested in participating and telling us their thoughts, we would love that. We’re very open to it, and we realize it really takes a whole community, and I think there’s no better place than to be at BMC for this because I think as an institution, this is something that people really recognize. It’s the type of healthcare that we want to aspire to.
Host: Thank you so much Dr. Bair-Merritt for coming on and explaining the Center for Urban Child and Healthy Family and to learn more about the center, you can go to bmc.org, that’s bmc.org. This is Boston Med Talks. I’m Melanie Cole. Thanks so much for tuning in.