Health Promotion

Strengthening Communities: A Conversation with Paul H. Dworkin, MD

Paul Dworkin-7501

Paul H. Dworkin, MD serves as executive vice president for community child health at Connecticut Children’s Medical Center, director of Connecticut Children’s Office for Community Child Health, and founding director of the Help Me Grow National Center. Dr. Dworkin is also a professor of pediatrics at UConn School of Medicine. This interview highlights the work of Connecticut Children’s Office for Community Child Health in strengthening communities. It was first published in the latest Community Benefit Report from Connecticut Children’s, which you can read here.

How does our approach to strengthening communities differ from other children’s hospitals?

Dr. Dworkin: We take a much more comprehensive look at community benefit in order to focus on strengthening communities. Like all not-for-profit medical centers, we deliver a great deal of care that is not adequately compensated so it’s appropriate for us to include that as a community benefit. However, we are also more proactive in identifying critical community issues, engaging partners in developing solutions in response to those issues, and championing the implementation and scaling of those interventions. We highlight all of those activities as major community benefits.

Describe the role of the Office as a state and national leader in community child health.

Dr. Dworkin: One of our key priorities is to develop local initiatives of statewide and national significance. On one hand, we want to be seen as a community resource and critical community partner, and we’re very mindful that we are located in Hartford, a city with great needs. On the other hand, we recognize the opportunity and obligation to design, implement, evaluate, and disseminate programs that can also have impact beyond Connecticut. Explicit principles guide our work, which yields impact due to strong partnerships at the state and federal level. For example, at the national level, our Help Me Grow National Center’s affiliate network and our partnership with federal agencies, such as the Maternal & Child Health Bureau, have afforded us the opportunity to guide national thinking in developing cross-sector comprehensive early childhood systems.

Read more from Dr. Dworkin on a nationwide effort by funders to transform child health services.

Describe the Office’s role in advancing social innovation.

Dr. Dworkin: Innovation is a big part of what we do. We recognize the significant gaps and capacity issues that limit our efforts to build comprehensive systems and strengthen families to promote children’s optimal healthy development. We need new approaches. We can’t be successful without broadening the tools, processes, measures, and metrics that we use to advance outcomes for children. We must develop novel solutions to contemporary issues that can be scaled and disseminated if proven successful. The science regarding the so-called biology of adversity, adverse childhood experiences, social determinants of health, and even the way in which our genetic expression is influenced by adverse circumstances demands new approaches. That is why we place great emphasis on developing and testing our own social innovations and supporting other innovators.

Describe the importance of the Office’s work in addressing social determinants of health.

Dr. Dworkin: The guiding principle in our work has been the recognition that while the quality of health services provided by physicians and surgeons at Connecticut Children’s is certainly important for all, especially for those with complex or chronic medical conditions, the outcomes we seek for children’s optimal health, development and well-being are disproportionately influenced by social, environmental and behavioral factors, and if we are not addressing all of those factors we will not ultimately be successful in helping children reach their full potential.

Read Dr. Dworkin’s thoughts on how we can better leverage Medicaid to transform child health services.

You are advocating for a child-first focus with healthcare transformation. Can you explain that?

Dr. Dworkin: At the federal and state levels, there has been a lot of focus on health services transformation. Healthcare reform has been about improving the quality of services provided by physicians as well as improving outcomes from those services; however, for pragmatic and other reasons, it has also perhaps disproportionately focused on cost savings. We spend a lot of money in this country without getting the outcomes we seek. Unfortunately, child health services are often left out of the discussion because the potential for immediate cost savings for children’s services is paltry compared to the potential savings among adults and people with chronic illness.

In collaboration with other organizations, we are making the case that child health services must be integral to current reform discussions due to the long-term cost savings that can be realized by intervening early and setting children on paths toward lifelong health and well-being. We’ve seen movement in that direction at the state and federal levels and believe we should elevate our discussion. We make our case for many reasons, such as the moral and ethical imperative that children are our future, the much greater return on investment available over the long term, and the critical importance of future workforce development. We stress these compelling arguments for why child health services transformation should be first and foremost rather than reluctantly included toward the bottom of the priority list.

Read additional blogs from Dr. Dworkin here.

Click here to learn more about Paul H. Dworkin, MD.

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