Multisector Collaborations at Children's Hospitals in the United States to Address Social Drivers of Health.

Abstract

Background: Child health is influenced by a range of social drivers. This necessitates a multipronged approach to pediatric care with collaborative efforts of multiple sectors. Children's hospitals have unique expertise and resources to identify pressing issues in child health and partner with community organizations and local governing bodies to address gaps in child health. The goal of this study was to identify multisector collaborations that children's hospitals in the United States engage in, facilitators and challenges of these efforts, and best practices that hospitals can employ to implement and sustain such collaborations.

Methods: An environmental scan was conducted utilizing the following approaches: a content analysis of Community Health Needs Assessments (CHNA) and implementation strategies at 35 children's hospitals, and semi-structured qualitative interviews with leaders who manage community partnerships at 14 select children's hospitals. This purposive sample was selected for national representation, including geographic location, size, and type of pediatric hospital. Qualitative relational analysis enabled exploration of descriptive and interpretive meanings within CHNA documents. Audio recordings were transcribed, the interview guide focused on domains of the Practical Robust Implementation and Sustainability Model (PRISM) implementation science framework, and interviews were conducted and analyzed by a team of qualitative researchers.

Results: Most hospitals engaged in multisector collaborations that addressed health disparities. The most frequently identified priorities included mental and behavioral health, access to health services, neighborhood safety and violence prevention, early childhood education, and chronic disease prevention. Key challenges were limited funding for multisector collaboration, shortage of staff with training and experience in multisector work, and variable readiness of community partners. Facilitators included adequate staffing and funding, community trust, and building on existing partnerships. All hospitals highlighted the crucial need to build trust within the community as a key factor to implement successful multisector collaborations. Best practices included examining the hospital's internal organization to avoid duplication of efforts, leveraging existing hospital resources to support local initiatives, incorporating community partners and financially supporting their efforts, creating avenues for bidirectional communication with community partners, measuring and tracking effectiveness of collaborations, and developing infrastructures to keep projects moving forward despite staff turnover.

Conclusion: Efforts to transform child health care from sick-care systems to community-integrated systems require children's hospitals to partner with community-based organizations to extend their reach and effectiveness. These findings can be used to develop strategies to implement and sustain future multisector collaborations at children's hospitals to effectively leverage their existing strengths and resources.