Transforming Well-Child Care to Meet the Needs of Families at the Intersection of Racism and Poverty.
Transforming Well-Child Care to Meet the Needs of Families at the Intersection of Racism and Poverty.
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DOI：
10.1016/j.acap.2021.08.004
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发表时间：
2021-11-01
影响因子：
3.1
通讯作者：
Coker, Tumaini R
中科院分区：
文献类型：
--
作者：
Liljenquist, Kendra;Coker, Tumaini R
由于历史上和当前基于阶级和种族的系统性压迫，种族主义和贫困在整个美国社会交织在一起。随着儿科预防性护理或儿童保健进程的发展，已更好地承认和解决由于种族主义和贫困造成的健康差距，护理结构基本上仍然停滞不前。为了培养黑人和棕色人种儿童的长期健康和福祉，我们必须采取一个明确的反种族主义结构，以提供良好的儿童保育。儿科医疗家庭模式被吹捧为解决儿童及其家庭的健康，发展和社会需求的黄金标准。然而，医疗之家模式并没有为生活在贫困中的黑人和棕色人种家庭带来更公平的照顾;有充分的数据表明，这些家庭往往得不到符合医疗之家原则的照顾。这种不平等可能在儿童保健方面最为突出，因为我们在儿科的预防保健服务有可能影响人口健康。为了适当地解决生活在种族主义和贫困交叉点的家庭的大量预防保健需求，需要对儿科医疗之家的预防保健进行结构性重新设计。在本文中，我们提出了一个重新设想的框架，结构良好的儿童保育，重点是照顾儿童的家庭生活在种族主义和贫困的交叉点。这个框架包括一个以团队为基础的方法来照顾家庭建立信任的初级保健关系与供应商，以及一个护理团队的非临床成员谁分享了生活经验与社区服务，并依赖于初级保健与社区组织的连接，支持预防健康，社会健康和幼儿家庭的情感健康需求。如果不对儿科医疗之家的预防性护理进行结构性重新设计，单独修订或扩大护理程序就无法适当解决种族主义和贫困对儿童预防性健康结果的影响。
Racism and poverty are intertwined throughout American society as a result of historic and current systemic oppression based on class and race. As the processes of pediatric preventive care, or well-child care, have evolved to better acknowledge and address health disparities due to racism and poverty, the structures of care have remained mostly stagnant. To cultivate long-term health and wellness of Black and Brown children, we must adopt an explicitly antiracist structure for well-child care. The pediatric medical home model is touted as the gold standard for addressing a host of health, developmental, and social needs for children and their families. However, the medical home model has not resulted in more equitable care for Black and Brown families living in poverty; there are ample data to demonstrate that these families often do not receive care that aligns with the principles of the medical home. This inequity may be most salient in the context of well-child care, as our preventive care services in pediatrics have the potential to impact population health. To appropriately address the vast array of preventive care needs of families living at the intersection of racism and poverty, a structural redesign of preventive care in the pediatric medical home is needed. In this paper, we propose a re-imagined framework for the structure of well-child care, with a focus on care for children in families living at the intersection of racism and poverty. This framework includes a team-based approach to care in which families build trusting primary care relationships with providers, as well as nonclinical members of a care team who have shared lived experiences with the community being served, and relies on primary care connections with community organizations that support the preventive health, social health, and emotional health needs of families of young children. Without a structural redesign of preventive care in the pediatric medical home, stand-alone revisions or expansions to processes of care cannot appropriately address the effects of racism and poverty on child preventive health outcomes.