Reach Out and Read is an important component of 3-2-1 IMPACT described here, “A Two-Generation, Early Childhood Advanced Primary Care Model.” The model has been piloted in three different clinics in the public hospital system, New York Health and Hospitals (including the clinic at Bellevue where I work). The lead author, Dr. Mary McCord, is the Director of Pediatrics at Gotham Health and Sydenham Health Centers. “We all know that the impact of Reach Out and Read is good and real, because research has proven it, and it comes at a time that has a long-time impact,” she told me. “We need to integrate ROR into a multipronged approach for early childhood support and additive effect.”
The approach combines ROR and the Video Intervention Project with women’s health, Healthy Steps, child life, and community health workers. My colleague, Dr. Suzy Tomopoulos — Medical Director of Pediatric Ambulatory Care at Bellevue Hospital, and an Associate Professor of Pediatrics at NYU, who is one of the authors — described the model as focusing on the first five years of life, with 0 to 3 the priority. ROR and VIP are provided to all families, and other services are tiered, based on maternal risk. There is screening for maternal depression, and screening for developmental milestones as well as for social emotional and behavioral milestones.
During the pilot, Dr. Tomopoulos said, “We cared for a lot of high-risk patients.” The pilot showed, she said, “we are able to implement an advanced primary care model to enhance long-term outcomes for children and parents.” She pointed in particular to the stigma attached to mental health issues, which can interfere with mothers getting help when they need it, and the importance of offering that care in the setting of the primary care clinic.
The next step is scaling up — and finding ways to approach payers and show that this can help hit benchmarks, “to enhance outcomes and get more dollars for preventive services in the first three years of life,” Dr. Tomopoulos said. “I think we need to be ambitious and think like that, how can we make pediatric primary care have a real impact, and how can we get the world of value-based care and population health and advanced primary care to recognize the importance,” Dr. McCord said. “We need to make the focus of primary care in the early years improving the social emotional outcomes of children.”
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