Imagine parents of babies looking forward to their visits to the pediatrician. In addition to tracking the baby’s growth and development, the pediatrician’s office would be the place to gain the kind of support that helps parents develop a healthy, nurturing relationship with their children, supporting the parent’s and baby’s overall social and emotional well-being.
This is the vision of Pediatrics Supporting Parents (PSP), a national systems transformation effort supported by six early childhood funders. Such a vision is easier said than done, especially when we consider the various stakeholders and perspectives that will need to be part of a community change initiative. Success will require parents, pediatric providers, and community partners to work collaboratively to ensure local conditions and contexts are elevated and acknowledged, parent and family voice is centered, and cultural values are recognized.
In an audacious approach, the funding partners will move decision-making power away from themselves and directly into the hands of the community, with parents and families co-designing the work at every stage of the process. We have partnered with five communities, each with their own collaborative networks, that will champion change that meets their local needs and is directly informed and led by the experiences of children, families, providers, and local partners.
Fortunately, each of these communities has its own unique experiences and lessons related to collaboration to inform the PSP journey. I sat down with Joy Lampkin Foster, Elizabeth Erickson, Bonnie Delaune, and Danielle Little, four members of the Durham Partners for Early Relational Health team, to gather their insights. The Durham team has a hefty resumé of existing collaboratives upon which they are building their PSP participation (e.g., READY Project, Early Childhood Action Plan, and NC Integrated Care for Kids). For PSP specifically, I was curious to learn more about who fundamentally needs to be at the table for this type of effort to be successful, especially collaborative work that pulls together the diverse experiences and perspectives of parents and clinicians who are driving change.
With the diverse networks of structures, partners, and individuals within and across each of PSP’s five proof point communities, we will need to figure out how to bridge differences in race, class, culture, power, and privilege. The Durham team reflected on their experiences and strategies around working through those differences.
They emphasized the importance of trust and creating a culture where all participants can be vulnerable. This creates an environment where individuals can acknowledge their personal realities and the challenges experienced in receiving or providing services within a larger system of care. Collaborative partners also need time and space to manage and prioritize their own health. This is especially important for parents who are asked to play a leadership role. Not only must we meet parents where they are and center collaborative practices around them, but we need to provide sufficient supports that set up parent leaders for success.
For Joy Lampkin Foster who serves as Durham Early Childhood Action Plan’s Racial Equity Consultant and Parent Partner, the lived experience of parents is exactly what needs to be supported. All parents have experiences affecting their social and emotional well-being. It is parents’ deep wisdom from these experiences that puts them in a position to lead this work, but we must ensure we are providing the support they need and want. The question before PSP is, “Are we prepared to give people the time and space to prioritize their own health while leading this project? How do we make sure we are not just asking folks to lead without doing the equitable thing of undergirding them with supports to be successful?”
"Are we prepared to give people the time and space to prioritize their own health while leading this project? How do we make sure we are not just asking folks to lead without doing the equitable thing of undergirding them with supports to be successful?"
Another important bridging strategy rests with communication and translation. Linguistic translation services are fundamental, but we also need to translate the way systems partners talk about the work, moving away from jargon so all participants from varying backgrounds are on the same page about what is discussed. This shift directly addresses power dynamics that exist due to class or education.
Confronting Inherent Obstacles
For the Durham team, this body of work is embedded within much larger conversations that their community is having around affordable housing, gentrification, gun violence, and other concerns. Unfortunately, many in the community aren’t considering the impact of early childhood health and development. The Durham team, however, fully acknowledges that parents’ social and emotional health and well-being along with relational health is so much more than just an early childhood issue. There is deep interconnection across issues, but the issues are often siloed by age range or system. Bonnie Delaune, the Durham Early Childhood Action Plan Manager, notes, “We need to be thinking about the context of supporting broader systems change because the power of collaborative work is bringing in the perspectives of other sectors with other life experiences.”
Dismantling siloes is just one of several concerns for the Durham team. Much of the existing collaborative structure is built around the Durham Early Childhood Action Plan which emerged from the Office of the Governor. While the intention and breadth of the plan is admirable, its development process reinforced a hierarchy of priorities and privilege. However, the team acknowledges that a positive shift took place once community leaders, frontline care providers working directly with families, and families themselves were engaged to help design the planning process. Now, it is the community members on the ground with lived experiences who are guiding the specific action plans.
Lessons from this process will help the team’s approach to their PSP engagement. “When I think about PSP and the obstacles we’ll face, I think about people’s discomfort with new ways of doing things. How do we inspire people to lean into the discomfort of not proceeding as usual,” reflects Joy Lampkin Foster. Power-sharing is a real barrier. While partners might talk about power-sharing and equity, the actual follow through is another story. Whether this is because people simply don’t want to share power or because they don’t know how to go about doing it is something to consider.
One last barrier is the health care system itself. While the Durham team hopes to see progress because champions are willing to take a risk, the reality is these champions work within deeply entrenched systems that may not be prepared to allow change to take hold more broadly. This begs the question: How can leadership and those who historically hold decision-making power in the health system be folded into the work from the outset?
Expanding the Tent of Partners
Those in each PSP community who are leading the local collaboratives must look in all directions to consider who needs to be involved in the initiative. Parents who are from the community and receiving direct support from the health system are fundamental to the success of the collaborative. In addition, the team noted that anyone who is part of the well-visit appointment journey and well-visit overall needs to have a seat at the table. This includes clinic leadership and pediatricians but also front desk staff, interpreters, and HealthySteps specialists among others. Outside of the four walls of the office, we need to consider the broader networks of community organizations who support families. It is especially important that community-based and community-rooted partners are part of the equation, not just the trusted partners or networks who have established relationships.
Elizabeth Erickson, a Pediatrician and Assistant Professor of Pediatrics at Duke Children’s Hospital and Health Center, acknowledged, “We have to understand and remember the family experience goes well beyond the walls of our practice, and we need to recognize that perhaps they don’t want to get everything from their pediatrician. There is so much history with a large health system; it can be imposing and not a trustworthy place. How can we open the doors and windows, so we’re not siloed to just pediatrics and the well visit, but leveraging the expertise of trusted community partners?”
The role of trust was a central tenet that emerged throughout our discussion, specifically trust among parents and providers. Danielle Little, who supports the Durham Children’s Initiative and the Partners for Early Relational Health, notes that “providers need to look like the community they serve and if not, they need to be supported because their role needs to go beyond allyship – it’s a deep awareness of the dynamics that families face.”
As the group considers the array of partners to bring into the collaborative, and potential perspectives that might be missing, representation from law or legal aid professionals is one opportunity to explore. Additional perspectives that might be valuable are community entrepreneurs or small business owners. These community partners can see and engage with a different viewpoint because they are not directly connected to early childhood issues but have a stake in the health of the community.
The Opportunity Ahead
The power of PSP is its goal to be rooted in the wisdom of parents, providers, and community. Durham Partners for Early Relational Health, along with the other four communities, will have the space to build their collaborative network’s internal capacity for parents, pediatricians, and community partners to co-create and share decision-making power. They will also share lessons across communities and local contexts, thus expanding the scope of possibility among the five communities and for the field more broadly.
For the Durham team, success is challenging norms by engaging in an equitable process that centers family voice, elevates their wisdom, and advances practice change that parents truly believe in. A process that embraces differences in perspectives and lived experiences, and works intentionally to bridge those differences, is the path to lasting systems change like elevating early relational health in pediatric care. In the words of the team, “Our success is not a deliverable, but success is allowing our community to decide what success will be and bringing that to fruition.”
"Our success is not a deliverable, but success is allowing our community to decide what success will be and bringing that to fruition."