DULCE Expansion Improves Infants' Routine Healthcare and Addresses Health-Related Social Needs

Dina Fico, MPH
Department of Medicine
Division of Global Health Equity
Poster Overview

Social determinants of health are responsible for an estimated 60% of health outcomes, and patients with unmet health-related social needs (HRSN) have worse outcomes and higher costs. DULCE (Developmental Understanding and Legal Collaboration for Everyone) is an evidence-based intervention that addressees HRSN for families with infants by embedding a community health working in an interdisciplinary team with an early childhood system leader, legal partner, pediatric and behavioral health clinician.

This project spread DULCE to five clinics in two states through a quality improvement Learning Collaborative, where teams adapted the intervention and shared data and learning on monthly webinars. As a result, between January 2017 and July 2018, the percent of families that completed all WCVs on time increased from 46% to 65%. Over 94% of families were screened for HRSNs, and 88% of those with positive screens received resource information. This study showed that quality improvement methods can be used to expand DULCE, a proven approach for pediatric clinics to support both infants’ healthy development and families’ HRSNs.

Scientific Abstract

Objective: The AAP recommends frequent well-child visits (WCVs) where providers screen for maternal depression (MD), intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach implementing these recommendations (DULCE, Developmental Understanding and Legal Collaboration for Everyone) to five clinics between January 2017 and July 2018. Our aims: 75% of infants receive all WCVs on time, 95% of families are screened for seven HRSNs, 90% of families with concrete supports needs and 75% of families with MD or IPV receive support.

Methods: Five DULCE teams – comprised of a community health worker, early childhood system representative, legal partner, pediatric and behavioral health clinicians – from two states participated in a Learning Collaborative. Teams adapted DULCE using quality improvement methods (e.g. Plan-Do-Study-Act cycles, run charts). The main outcomes were the percent of infants that received all WCVs on time, families screened for HRSNs and provided support.

Results: The percent of families that completed all WCVs on time increased from 46% to 65%. Over 94% of families were screened for HRSNs; 88% of those with positive screens received resource information.

Conclusion: QI-supported DULCE expansion increased by 50% the proportion of infants receiving all WCVs on time and reliably addressed families’ HRSNs.

Clinical Implications
This study showed that quality improvement methods can be used to expand DULCE, a proven approach for pediatric clinics to support both infants’ healthy development and families’ health- related social needs.
Research Areas
Authors
Dina Fico, MPH, Baraka Floyd, MD, MSc, Samantha Morton, JD, Patsy Hampton, Jennifer Murphy Sims, PT, DPT, PCS, Stephanie Doyle, Sidney Atwood, BA, Robert Sege, MD, PhD, MaryCatherine Arbour, MPH, MD
Principal Investigator
MaryCatherine Arbour, MPH, MD

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