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Need Parenting Help? Therapy? Food? California Pediatrician Offices May Soon Be Able to Help

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Starting next July, Medi-Cal will offer a new benefit to help pay for more preventative care at families’ routine pediatrician’s appointments. It’s called dyadic care, a complicated term for the fairly simple concept of serving children and their parents together rather than on their own.

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Need Parenting Help? Therapy? Food? California Pediatrician Offices May Soon Be Able to Help

“If the mom who is bringing the baby in is suffering from maternal depression, or from food insecurity, that is very much the business of the pediatrician, because it's going to affect the child's ability to thrive,” said Sarah Crow, managing director of the First Five Center for Children’s Policy.

The new Medi-Cal benefit is designed to cover the cost of someone like a community health worker — a person could connect families to resources like food banks, legal aid, parenting classes or therapy before they leave the doctor’s office.

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“The social and emotional development that they go through in those first several months, really literally transforms the architecture of their brain for their lives,” said Northeast Valley Health Corporation pediatric medical director Gina Johnson. “If we can intervene in a way to support patients and families at this earliest time in their life, we can actually make a difference.”

Parents Have Questions, They Have Answers

When Michelle Humphrey became a mom her relationship with Google changed.

Searches for recipes turned into “Is it normal for my kid’s butt to be this color?” “My kid has a bubble on his gums, what does that mean?”

“There's just so many things that nobody knows as a parent until you are in the middle of it,” Humphrey said.

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But there were challenges she couldn’t solve online.

After her younger son Oliver was born two years ago and the family downsized into a smaller home in Temecula, her older son Boden’s behavior changed. He went from almost fully potty-trained to having accidents. Bouts of aggression included hitting and biting.

“I think he just had a compound of like, multiple big changes in his life,” Humphrey said. "They weren't all bad, but it was just things that like, his little tiny, 3-year-old brain couldn't handle.”

A woman in a salmon colored jumpsuit and floral mask holds 5-year-old and 2-year-old boys on her lap.
The Humphrey family, 2-year-old Oliver, Michelle and 5-year-old Boden.
(Mariana Dale/ LAist)

She brought her questions to her next pediatrician’s appointment at Children's Primary Care Medical Group — not to the doctor, but to HealthySteps specialist Bella Lopez.

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The HealthySteps program places a child development expert in routine well-child visits to answer parent’s questions, conduct developmental and mental health screenings and navigate the local web of resources.

“The doctors are here to look at physical well being, and I'm here really for any other concerns,” Lopez said, estimating she’s seen more than a thousand kids virtually and in-person in the last year.

The early childhood non profit ZERO TO THREE manages 200 HealthySteps sites nationwide and recently secured a grant to expand to at least six new sites in L.A. County next year.

A woman in a grew sweater sits in a pediatricians office.
"When we first started the program my job was was really trying to find every possible resource in the area that's affordable, accessible, and you know, doesn't have a six-month-long waitlist," Lopez said.
(Mariana Dale/ LAist)

First 5 Riverside County funded Temecula’s program in 2018. In the years since then, Lopez has built up a bank of local resources for everything from sleep training to virtual learning.

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She initially connected Humphrey to a parenting class and a clinic that took Medi-Cal and offered therapy for parents and young kids.

“[It] made me feel like I have an ally, a liaison to help me find answers that I can't find myself,” Humphrey said.

Once Boden and Oliver are older, Humphrey is thinking about becoming a doula or a lactation consultant, jobs where she could pass on what she’s learned to other parents.

Doctors Love The Program, But Struggle To Pay For it

A 2019 state audit found 2.4 million kids a year enrolled in Medi-Cal don’t get preventative services like behavioral and mental health screenings, immunizations and dental care.

Research shows that HealthySteps families receive more preventative and developmental services, are more likely to get vaccines on schedule and are more satisfied with their health care overall.

One factor is that the specialists have a luxury many doctors don’t — time.

At Northeast Valley Health Corporation’s San Fernando and Santa Clarita Valley clinics, doctors see a patient roughly every 15 minutes, said Johnson.

The organization piloted a program similar to HealthySteps called DULCE, where a specialist met with families through their child’s first six months of doctor appointments. The program also includes access to legal guidance.

Johnson said the family specialists painted a more complete picture of a family’s circumstances, from transportation troubles to food insecurity.

If we can intervene in a way to support patients and families at this earliest time in their life, we can actually make a difference.
— Gina Johnson, Northeast Valley Health Corporation pediatric medical director

“If we can meet more than the immediate need that they have right there, then we can bring health to the whole patient and the whole family,” Johnson said.

An evaluation of DULCE across several states found the majority of participating families received resources related to financial assistance, behavioral health and housing instability and maternal depression.

Like HealthySteps in Riverside County, DULCE was supported by outside funding. Despite the program’s popularity, Northeast Valley wasn’t able to sustain it after the grant from First 5 LA ran out in 2020.

“The community health worker role is the linchpin of the DULCE approach, but it's also the piece that requires additional funding that many communities are really grappling with,” said Azieb Ermias, who helps oversee DULCE at the Center for the Study of Social Policy.

Part of the reason is that providers often can’t bill for the services the specialists or health workers provide to families.

“That's key because you need to be able to bill in order to support staffing to provide these types of services,” said Kate Margolis, a pediatric psychologist who directs the division of integrated behavioral health at San Francisco General Hospital. She led a team that pushed California to create the dyadic care benefit.

“The work that we have been doing... around payment reform is really about changing the way that services can be [billed] and shifting services to be more preventative,” Margolis said.

Those preventative services can save money. One evaluation of HealthySteps found the program had a 163% return on investment for Medicaid patients.

“By providing those supports based on just the presence of risk, we really can get ahead of problems before they get worse,” Margolis said.

What questions do you have about early childhood education and development? What do you want to know about kids ages 0-5 and those who care for them in Southern California?
Decades of research indicates early childhood education significantly boosts children’s readiness to learn. Mariana Dale wants families, caregivers and educators to have the information they need to help children 0-5 grow and thrive by identifying what’s working and what’s not in California’s early childhood system.