Early Childhood Integrated Behavioral Health: A Promoter of Equity in Pediatric Care

Objective: This topical review examines an equity-focused parenting intervention and how it addresses structural problems in health care that perpetuate inequities for marginalized groups. Methods: Four domains of pediatric primary care (PPC) that perpetuate health inequities are discussed, including (a) acontextual, individual patient focus of health care; (b) fragmented and siloed networks of care; (c) limited cultural awareness in care; and (d) diagnosis-driven health care benefits. Next, a model of two-generational primary care behavioral health is discussed as a way to mitigate structural aspects of PPC that contribute to inequities. Results: Integrating early childhood behavioral health into PPC, a system designed to provide universal prevention and health promotion, can enact a transformative impact on a traditionally racist system of health care. The following specific mechanisms of this model are discussed: (a) expanding the acontextual, individual patient focus; (b) providing care coordination that mitigates fragmented and siloed networks of care; (c) engaging in reflective practice to enhance cultural awareness in care; and (d) shifting from diagnosis-driven to family-centered paradigms. Conclusions: Implications for practice, clinic transformation, and systems-related policy changes that can shift structural policies that perpetuate racism and oppression are discussed. Implications for Impact StatementCertain structures within pediatric primary care perpetuate race-based inequities. Integrated behavioral health for families with young children is one strategy to promote antiracism and health equity in pediatric care. HealthySteps, an evidence-based model of caregiver-focused, early childhood behavioral health, is offered as an example of equity-promoting care.