Capacity Building
Early Relational Health
Health care providers and Families are not routinely trained to truly understand and "see" each other, or journey together through the healthcare system. To address this gap, we partnered with parents and providers in our primary care community to co-design a Relational Health (ERH) toolkit for both pediatric resident training and the families they support. The resulting toolkit equips residents with skills for building strong partnerships and practicing attuned, relationship-centered communication with children and their caregivers. For families, the toolkit provides parent-to- parent affirmation and provides resources to further strengthen their relationship with their child and the providers who support them. This work represents an important first step in strengthening caregivers and providers’ capacity to support the foundational relationships that shape early development.
A core feature of our process was elevating parent voice as an essential element of pediatric education. Our goal is to ensure that lived experience becomes an expected and valued component in training related to parenting, child behavior, and development—ultimately shaping how well-child care is delivered.
Collaborative systems change via TONIC
Child Welfare
CA invested billions of dollars in Medicaid reform through CalAIM. Working with our partners and families, the Toxic Stress Network Improvement Collaborative (TONIC) identified an opportunity to connect children exiting the foster care system to preventative Medi-Cal benefits, such as Enhanced Care Management, so that these children and their families can thrive and avoid reentry into the system.
TONIC has employed the following process to navigate and build its partnerships through the public systems that interface with the Child Welfare System:
- Conducting a Landscape Analysis
- Identifying Opportunities in ECM
- Building a Data Consent Toolkit
- Launching a Child Welfare Family Maintenance Pilot
- Building Community Pathways
Dyadic Care
In 2019 TONIC partners developed a plan to sustain a new pilot program integrating behavioral health specialists into the busiest public health clinic in San Francisco.
Using evidence gathered from the pilot’s success, our partners successfully advocated to make dyadic care a recognized and reimbursable benefit of Medi-Cal—improving the wellbeing of over 5 million young children and young adults on Medi-Cal and their families across the State.
TONIC with R3!'s Family Accountability Board continues to work with the Center for Advancing Dyadic Care in Pediatrics as it supports the integration of dyadic care into clinical practices across California.
Developmental Screening
Developmental screening plays a critical role in identifying young children who may be at risk for developmental delays, ensuring they receive timely support and intervention. Through collaborative efforts, TONIC worked to support the expansion of access to evidence-based screening tools such as the Ages and Stages Questionnaires (ASQ), especially in reaching communities most impacted by inequities, in order to reduce disparities in developmental outcomes. TONIC’s Developmental Screening Project resulted in the first data use agreement signed by the managed care plans, and this collaboration laid the relational groundwork for the projects that followed.
Transformative primary care models focused on 0-5-year-olds and their families
R3! is grounded in multiple innovative clinical care models:
UCSF Center for Advancing Dyadic Care in Pediatrics
Housed at UCSF, the Center’s vision is to make family-centered, dyadic behavioral health promotion and prevention a routine and sustainable standard of pediatric health care in early childhood. CADP grounds its work in a thriving dyadic care practice within the Children’s Health Center where the majority of CADP staff also practice and lead clinical services. The UCSF CADP is an official Technical Assistance Vendor for Dyadic Care for the California Department of Health Care Services.
Joyful Parenting
Black Joyful Parenting (BJP) is an evidence informed, peer support parenting group for families and children aged 0-5 that focuses on managing stress, promoting resilience, and strengthening relationships to nurture early relational health. This is done through a 6 week psychoeducation curriculum going over toxic stress, mindfulness techniques, self-regulation and understanding your child's emotions. Most families are referred to BJP through the Bloom Clinic if an adverse event is discussed with a provider or if a child has a PEARL score of one or more. The curriculum is culturally adapted from the original Resilience Clinic curriculum called Circle of Security which encourages parents to really think about the experience of their child. How they want to parent, what they don't want to do, what their experience with parenting was growing up and how they want to change that?
Resiliency Clinic
The Resiliency Clinic is an interactive group-based intervention for parents and caregivers of young children ages zero to three with a history of significant adversity. Groups are designed to teach mindfulness and other resilience-promoting skills and to strengthen parent-child relationships as a protective factor against adversity. The Resiliency Clinic curriculum includes materials developed by our partners at Dovetail Learning - We are ResilientTM - designed to teach mindfulness-based stress management tools for adult caregivers to use, model and teach in their day-to-day responsibilities and interactions with their children.