Integrating Social and Emotional Care Across the First Thousand Days in Safety-Net Health Care

Although the first thousand days are recognized as a critical period, health clinicians struggle to adequately address unmet social and emotional needs during this time, and attempts to do so are often siloed. To create a collaborative, population-based model, our hospital committed to integrating interdisciplinary social and emotional care continuously wherever patients were routinely seen for medical care at 3 touchpoints (prenatally, mother-baby unit/neonatal intensive care unit, and pediatric well-child visits) through the Brooklyn Parenting Center (BPC). We describe how the BPC adapted Strengthening Families' 5 principles of protective factors to change maternal-child health in our hospital via (1) providing universal access to continuous integrated social and emotional support throughout the first thousand days; (2) using evidence-based models to address unmet social and emotional needs; and (3) supporting parents to become the caregivers they want to be through optimizing positive development for their children. We further describe implementation steps, successes, and lessons learned that could apply in other health care settings. Implementing and sustaining the BPC required coalition building and advocacy in the community and across multiple departments within the hospital. Through collaboration with a community advisory board, the BPC created a population-based model of care with a trauma-informed lens to detect needs and provide support in a patient-centered manner. Efforts to continue optimizing outcomes will require including family input, increasing the workforce to meet the demand uncovered by these efforts, and building on current sustainability plans to make a case for increased cost savings measures in the face of bundled care.