BACKGROUND AND OBJECTIVES: Academic primary care clinics often care for children from underserved populations affected by food insecurity. Clinical-community collaborations could help mitigate such risk. We sought to design, implement, refine, and evaluate Keeping Infants Nourished and Developing (KIND), a collaborative intervention focused on food-insecure families with infants. METHODS: Pediatricians and community collaborators codeveloped processes to link food-insecure families with infants to supplementary infant formula, educational materials, and clinic and community resources. Intervention evaluation was done prospectively by using time-series analysis and descriptive statistics to characterize and enumerate those served by KIND during its first 2 years. Analyses assessed demographic, clinical, and social risk outcomes, including completion of preventive services and referral to social work or our medical-legal partnership. Comparisons were made between those receiving and not receiving KIND by using χ2 statistics. RESULTS: During the 2-year study period, 1042 families with infants received KIND. Recipients were more likely than nonrecipients to have completed a lead test and developmental screen (both P < .001), and they were more likely to have received a full set of well-infant visits by 14 months (42.0% vs 28.7%; P < .0001). Those receiving KIND also were significantly more likely to have been referred to social work (29.2% vs 17.6%; P < .0001) or the medical-legal partnership (14.8% vs 5.7%; P < .0001). Weight-for-length at 9 months did not statistically differ between groups. CONCLUSIONS: A clinical-community collaborative enabled pediatric providers to address influential social determinants of health. This food insecurity–focused intervention was associated with improved preventive care outcomes for the infants served.

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Economic, environmental, and psychosocial needs are common and wideranging among families cared for in primary care settings. Still, pediatric care delivery models are not set up to systematically address these fundamental risks to health. We offer a roadmap to help structure primary care approaches to these needs through the development of comprehensive and effective collaborations between the primary care setting and community partners. We use Maslow's Hierarchy of Needs as a well-recognized conceptual model to organize, prioritize, and determine appropriate interventions that can be adapted to both small and large practices. Specifically, collaborations with community organizations expert in addressing issues commonly encountered in primary care centers can be designed and executed in a phased manner: (1) build the case for action through a family-centered risk assessment, (2) organize and prioritize risks and interventions, (3) develop and sustain interventions, and (4) operationalize interventions in the clinical setting. This phased approach to collaboration also includes shared vision, codeveloped plans for implementation and evaluation, resource alignment, joint reflection and adaptation, and shared decisions regarding next steps. Training, electronic health record integration, refinement by using quality improvement methods, and innovative use of clinical space are important components that may be useful in a variety of clinical settings. Successful examples highlight how clinical-community partnerships can help to systematically address a hierarchy of needs for children and families. Pediatricians and community partners can collaborate to improve the well-being of at-risk children by leveraging their respective strengths and shared vision for healthy families.Pediatricians and primary care centers embrace the importance of identifying and acting on the economic, environmental, and psychosocial needs faced by their patients and families. Early recognition and action on these social determinants of health (SDH) are increasingly seen as critical, given their known impact on morbidity and mortality. [1][2][3] The related toxic stress model suggests that adverse childhood events often rooted in the SDH disrupt physiologic processes and cause such experiences to "get under the skin."This places children at risk for adverse health and developmental outcomes that can persist into adulthood. 4,5 Defining, identifying, and mitigating these toxic stressors could therefore promote childhood resilience, positive development, and health later in life.There are increasing calls to reshape pediatric care to better address the SDH. The American Academy of Pediatrics has outlined principles of patient-and family-centered care that include supporting and empowering children and families across the life

Successful MLP implementation enabled pediatric providers to address social determinants of health potentially improving health and reducing disparities.

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