Adam Schickedanz

Redesigning Health Care Practices to Address Childhood Poverty

Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them. Identification of needs can be accomplished with a variety of established screening tools. Interventions may include resource directories, best maintained in collaboration with local/regional public health, community, and/or professional organizations; programs embedded in the practice (eg, Reach Out and Read, Healthy Steps for Young Children, Medical-Legal Partnership, Health Leads); and collaboration with home visiting programs. Changes to health care financing are needed to support the delivery of these enhanced services, and active advocacy by child health providers continues to be important in effecting change. We highlight the ongoing work of the Health Care Delivery Subcommittee of the Academic Pediatric Association Task Force on Child Poverty in defining the ways in which child health care practice can be adapted to improve the approach to addressing child poverty.

Childhood Poverty: Understanding and Preventing the Adverse Impacts of a Most-Prevalent Risk to Pediatric Health and Well-Being

Poor children are at greater risk for worse health, less productivity, and harms to well-being that extend into adulthood and subsequent generations. Timing and duration of poverty matter and influence life course outcomes, especially for education, health, and lifetime productivity. This article focuses on interventions by policy advocacy and the pediatric health system, and protection of the health and well-being of families in economic hardship from disadvantages and trauma wrought by poverty. A framework is presented for child poverty prevention and its consequences for lifelong health and success on a national scale.

Childhood Poverty and Its Effect on Health and Well-being: Enhancing Training for Learners Across the Medical Education Continuum

OBJECTIVE Childhood poverty is unacceptably common in the US and threatens the health, development, and lifelong well-being of millions of children. Health care providers should be prepared through medical curricula to directly address the health harms of poverty. In this article, authors from The Child Poverty Education Subcommittee (CPES) of the Academic Pediatric Association Task Force on Child Poverty describe the development of the first such child poverty curriculum for teachers and learners across the medical education continuum. METHODS Educators, physicians, trainees, and public health professionals from 25 institutions across the United States and Canada were convened over a 2-year period and addressed 3 goals: 1) define the core competencies of child poverty education, 2) delineate the scope and aims of a child poverty curriculum, and 3) create a child poverty curriculum ready to implement in undergraduate and graduate medical education settings. RESULTS The CPES identified 4 core domains for the curriculum including the epidemiology of child poverty, poverty-related social determinants of health, pathophysiology of the health effects of poverty, and leadership and action to reduce and prevent povertys health effects. Workgroups, focused on each domain, developed learning goals and objectives, built interactive learning modules to meet them, and created evaluation and faculty development materials to supplement the core curriculum. An editorial team with representatives from each workgroup coordinated activities and are preparing the final curriculum for national implementation. CONCLUSIONS This comprehensive, standardized child poverty curriculum developed by an international group of educators in pediatrics and experts in the health effects of poverty should prepare medical trainees to address child poverty and improve the health of poor children.

Developing the PedsValue Modules—A National Pediatric High Value Care Curriculum

From the Departments of Medicine and Pediatrics, Duke University School of Medicine (Drs Avery and Woods), Durham, NC; Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine (Dr Beck), Seattle, WA; Department of Pediatrics, UCSF Benioff Children’s Hospital (Dr Padrez), San Francisco, CA; Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine (Dr Walker), Houston, TX; Department of Pediatrics, Cincinnati Children’s Hospital Medical Center (Dr Herrmann), Cincinnati, OH; Department of Pediatrics, Lucile Packard Children’s Hospital Stanford (Dr Schroeder), Palo Alto, CA; and Department of Pediatrics, David Geffen School of Medicine at UCLA (Dr Schickedanz), Los Angeles, CA The authors have no conflicts of interest to disclose. Address correspondence to Carolyn S. Avery, MD, MHS, 4020 N Roxboro St, Durham, NC 27704 (e-mail: carolyn.avery@duke.edu).

Surveillance and Screening for Social Determinants of Health—Where Do We Start and Where Are We Headed?

Dr. Esther Chung and her colleagues have written a timely review for all child health clinicians that addresses the social determinants of health with special emphasis on children who live in poverty. Her review is accompanied by an excellent commentary written by Drs. Adam Schickedanz and Tumaini Coker from UCLA. This review is particularly timely given the American Academy of Pediatrics’ (AAP) recent publications, a Technical Report and a Policy Statement regarding childhood poverty. In addition, the Academic Pediatric Association and the AAP recently created task forces to address child poverty. This paper begins by describing the magnitude of childhood poverty in the United States and the importance of understanding the causal factors that mediate the adverse effects of poverty. She explains the difference between surveillance and screening and why both are important in the context of social determinants of children’s health. She then provides the reader with overviews of 10 important social determinants of children’s health. These include child maltreatment, child care and

Addressing Family Homelessness in Pediatrics: Progress and Possibility

Homelessness during pregnancy or childhood should be unthinkable in a society that treats children and families with dignity. In this issue of Pediatrics , Sandel et al1 provide new evidence from 5 cities on just how damaging homelessness in pregnancy and early childhood are to child health. Their study, “Timing and Duration of Pre- and Postnatal Homelessness and the Health of Young Children,” included >20 000 child-caregiver dyads, and they found that children who had been homeless were more likely to have previous hospitalizations, developmental delay, and worse health overall.1 The effects were largest in families who were homeless both before and after a child’s birth and in families who were homeless for more than 6 months while their child was an infant or toddler. This study addresses a key … Address correspondence to Adam Schickedanz, MD, PhD, Department of Pediatrics, University of California, Los Angeles, 10960 Wilshire Blvd, Suite 960, Los Angeles, CA 90024. E-mail:aschickedanz{at}mednet.ucla.edu

Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care

The social determinants of health (SDoH) are defined by the World Health Organization as the “conditions in which people are born, grow, live, work, and age.” Within pediatrics, studies have highlighted links between these underlying social, economic, and environmental conditions, and a range of health outcomes related to both acute and chronic disease. Additionally, within the adult literature, multiple studies have shown significant links between social problems experienced during childhood and “adult diseases” such as diabetes mellitus and hypertension. A variety of potential mechanisms for such links have been explored including differential access to care, exposure to carcinogens and pathogens, health-affecting behaviors, and physiologic responses to allostatic load (i.e., toxic stress). This robust literature supports the importance of the SDoH and the development and evaluation of social needs interventions. These interventions are also driven by evolving economic realities, most importantly, the shift from fee-for-service to value-based payment models. This article reviews existing evidence regarding pediatric-focused clinical interventions that address the SDoH, those that target basic needs such as food insecurity, housing insecurity, and diminished access to care. The paper summarizes common challenges encountered in the evaluation of such interventions. Finally, the paper concludes by introducing key opportunities for future inquiry.