The pediatric primary care setting provides a near-universal opportunity to support the youngest patients and their caregivers, strengthening vitally important foundational relationships and promoting social and emotional development. When it launched in 2017, the Pediatrics Supporting Parents (PSP) initiative set out to explore core practices that are at the heart of the effective well-child visits—or routine medical “check-ups”—and identify ways to spread their use across the country. They include:

• Offering parents/caregivers reassurance and guidance on nurturing their child’s health and growth;
• Conducting child health and developmental screenings and providing links to needed early intervention;
• Adopting family-centered procedures that ensure connections to behavioral health supports for adults and children; and
• Providing connections to services families may need to address social and economic concerns.

When PSP began, we never imagined how rigorously these core practices would be tested each day. The devastating health and financial hardships imposed by the COVID-19 pandemic—and the stark truths exposed about racial inequities and health disparities—have reinforced the indispensable value of a family-centered approach.

To harness the potential of the pediatric primary care setting to benefit more young children and their families, the PSP initiative looked to Medicaid and the Children’s Health Insurance Program (CHIP), which cover nearly half of young children in the United States. Backed by the generous support of the PSP funding consortium, we produced, Fostering Social and Emotional Health through Pediatric Primary Care: A Blueprint for Leveraging Medicaid and CHIP to Finance Change (The Blueprint). This practical guide, designed for state policymakers and program administrators, and useful to managed care plans, family-led organizations, and advocacy groups, presents five actionable strategies for using Medicaid and CHIP policies and financing mechanisms to improve pediatric primary care.

We closed our PSP inaugural blog post, published in spring of 2019, with words of hopeful anticipation:

“Where will seasoned and emerging leaders take these opportunities? How will their efforts further the role Medicaid and CHIP play in advancing our children’s future academic, social, and economic success? With great excitement, we are looking forward to the … innovations that are about to materialize ..!”

Barriers and Setbacks

Now, 18 months down the road, we are checking in to report on how a workgroup of nine state teams—California, Kansas, Maine, Massachusetts, New York, Nevada, North Carolina, Virginia, and Wisconsin—is using the Blueprint and customized technical assistance to implement new Medicaid and CHIP policies and payment procedures.

It will come as no surprise that each and every state is facing unprecedented obstacles, not the least of which is the widespread, serious impact of COVID-19 and the precipitous economic decline that has constricted state budgets. However, although safety issues have driven an alarming decline in primary care visits, health care agencies and organizations have prioritized outreach to the families of the youngest children who still need immunizations, screenings, and connections to social services and mental health supports. Perhaps of greatest concern are the many thousands of children and families grappling with the trauma associated with the illness and deaths of loved ones.

Yet, these bumps in the road did not derail our state teams. In fact, they exhibited even greater resolve to address the challenges facing families, by expanding telehealth policies, jumpstarting opportunities to deploy community health workers, and finding new ways to help families with young children cope with unrelenting stress and adversity. In more than one instance, state teams have framed their PSP work as an integral component of the state’s COVID-19 response.

Breakthroughs and Progress

Over the next few months, we’ll share accomplishments from the state teams and describe how they advanced pediatric primary care in new ways:

• Used CHIP administrative funds to embed early literacy promotion in pediatric primary care;
• Designed a Maternal Depression Screening protocol and payment policy for pediatric care providers;
• Assembled the puzzle pieces to show how Medicaid can support the elements of “dyadic care models”—approaches that consider the needs of the “dyad,” the child and caregiver together;
• Pushed to allocate more resources to children in health care delivery transformation efforts; and
• Pursued Medicaid-financed opportunities for realizing team-based care initiatives.

This blog series aims to be a platform for elevating new approaches and for considering the voices of policymakers, practitioners, and parents. We hope that the PSP lessons we share will help equip public programs to address the needs of young children and their families in these very challenging times and beyond.