Promising Practices: First Year Families – Washington State

First Year Families – Washington State

First Year Families (FYF) was a collaborative project focused on early relational health organized by the Washington Chapter of the American Academy of Pediatrics (WCAAP) and funded by the Perigee fund from 2020-2021. Many pediatricians in Washington State identified perinatal mood disorders as a major concern within their practices and a priority recommendation from the American Academy of Pediatrics (AAP). However, pediatricians had concerns about time required for screening, implications for billing, ways to universalize strategies and availability of referral resources when concerns were identified. Understanding these issues, FYF designed a project that would support a cohort of pediatric practices to implement perinatal mood disorder screening and improve referral systems in their communities.

The project’s two main outcomes were to 1) ensure 80% of eligible primary caregivers would be screened for perinatal mood disorders during the first eight months of an infant’s life; and 2) support a “closed loop” referral, integrating follow up to address identified needs, for 80% of caregivers who were identified as needing support through the Edinburgh Postnatal Depression Screener (EPDS). In addition to the two main outcomes, culturally competent care was key to the work, gathering and analyzing data from the community in order to define solutions that work for the diverse families served within the cohort. To achieve these outcomes, FYF established and maintained a learning collaborative and a steering committee, offering professional support in making changes within practices while also building community partnerships that would offer broader support in the long-term.

The Role of the Learning Collaborative

In Yakima and Pierce Counties, learning collaborative participants included four pediatric practices, including two Federally Qualified Health Centers and two private practices, serving families in six sites. To increase capacity of pediatric practices to conduct, interpret, and refer based on the EPDS, the project recruited a staff member from each practice who was passionate about relational health. These individuals served as the practice’s “champion” and participated in all learning collaborative activities, working closely with FYF staff to reach project outcomes by promoting education and enhancing systems within their own practices.

Aligned with project outcomes, the learning collaborative specifically focused on the EPDS tool and referral to mental health resources for adult caregivers. All staff from each practice participated in three meetings. The kickoff meeting provided background on perinatal mood disorders and its impact on child development, rationale for the project and the role of the collaborative. Regular cohort calls provided opportunities for champions to participate in education, information sharing and collective problem-solving. These calls were designed to support participants in learning from experts, sharing their own experiences and gaining ideas from each other. Additionally, monthly one-on-one calls between FYF staff and champions provided more in-depth coaching to promote each practice’s progress and address any challenges or barriers. Finally, all practice staff were invited to participate in four supplemental webinars on attachment, paid family and medical leave, parental voice and county-specific Help Me Grow programs. Together, these professional development strategies offered multiple opportunities to learn about and integrate early relational health in their practices, specifically focusing on screening to identify and address adult caregiver mental health concerns within the postnatal period.

To support referrals once caregiver needs were identified, FYF staff collaborated with partners to develop resources for practices and promote referrals. Champions worked to enhance referral systems within their practices to ensure every referral led to services. Additionally, FYF staff conducted an environmental scan and developed resources to inform practices of the organizations available to respond to referrals. This effort supported practices in reaching the second outcome of ensuring 80% of caregivers with needs identified within the EPDS accessed services.

The Steering Committee

FYF staff recruited local leaders and stakeholders invested in early relational health from across the state of Washington to participate in the project’s Steering Committee. The committee included representatives from relevant professional fields (pediatrics, family medicine, psychiatry, obstetrics, birth doulas), community organizations (The Maternal Coalition, Washington State Health Care Authority, Washington Association for Infant Mental Health, Open Arms Perinatal Services, Washington State Fathers Association, American Indian Health Commission and more), and two parent advocates, both of whom were women of color. Partnership with the steering committee helped foster improved systems, policies and investments to promote early relational health, family well-being and early childhood development.

Meeting on a bimonthly basis, the steering committee worked together to understand, prioritize and act on strategies to support early relational health and identify/address perinatal mood disorders. Steering committee leadership asked members to detail the salient issues, barriers and “golden asks” that would drive the work of the FYF project. Within this exercise, the steering committee identified six priorities including culturally competent, community-focused care; exploring expanded or innovative staffing models for clinics; traversing prenatal and postnatal care silos; and exploring alternate payment models. When asked to narrow choices down to two, culturally competent, community-focused care and exploring expanded or innovative staffing models were selected as the most critical areas of focus.

Once the priorities were narrowed, the steering committee identified community health workers as a solution that would address both areas. Members noted that recruiting individuals from the community regardless of licensure could be a culturally competent, community-focused solution, while also supporting practices in innovative staffing models that would promote screening and identification of individuals with perinatal mood disorders. Ensuring licensure was not a job requirement reduced barriers to hiring individuals who could best serve the community.

The steering committee drafted an advisory statement for the state legislature which evolved into a line item within the state budget dedicated to pediatric community health workers working with families of children from birth to five and the teenage years. Additionally, the state legislature included another line item to support pediatric practices in delivering integrated behavioral health services for children and families. Through this work, the steering committee built beyond the scope of supporting practices through professional development and relationship building to supporting advocacy and policy change at the state level.

Lessons Learned

Successful integration of early relational health into pediatric practices requires several critical components including intensive involvement of parents and “buy-in” of leadership within the practice. Parent participation in educational experiences within the learning collaborative and as voices on the steering committee promoted a family-centered, culturally competent approach. Participants described the powerful impact of hearing from parents who had been through the screening process, and who could state the value of being asked about their own health and wellness during the post-partum period. Additionally, parental voices on the steering committee led to priorities and solutions that accurately addressed community needs in innovative ways.

Each practice was able to integrate components of the project in different ways depending on their resources and organizational structure. Yet, competing priorities pulled attention away from initiatives champions were working to implement. FYF staff identified that future efforts to improve health services within practices will need to include both a staff champion and practice leadership who prioritize the area of focus. Using this simultaneous practical- and leadership-driven approach will promote multi-level problem-solving to remove barriers to implementation, ensuring all practitioners access resources needed to support early relational health.