While there is a growing understanding that a child’s first few years strongly impact their future health and success, evidence suggests that access to necessary care and services remains limited.1 For example, of the children referred to IDEA Part C (a federal early intervention program for young children with disabilities) between July 2021 and June 2022, only 53% were ultimately enrolled.2 The Early Childhood Developmental Health Systems (ECDHS): Evidence to Impact Center helped states and communities improve these outcomes by building strong, lasting early childhood developmental health systems – networks of organizations and services (e.g., pediatric care, family support) that work together to help babies, toddlers, and their families grow and thrive.
To guide the ECDHS: Evidence to Impact Center’s technical assistance with state and community teams, they held focus groups and interviews with pediatricians to learn about factors that affect a young child’s ability to get services across the full range – or continuum – of early childhood developmental care that supports the health and well-being of families. This continuum includes promotion and prevention, monitoring and screening, care coordination and linkage, and intervention.
The ECDHS: Evidence to Impact Center shared their research in a poster presentation at the 2025 Pediatric Academic Societies Conference, focusing on three key themes: facilitators to strong early childhood systems (i.e., helpful strategies, resources, or concepts), challenges, and opportunities to strengthen systems.
Highlights include:
Read on for further details about these facilitators, challenges, and opportunities.
The ECDHS: Evidence to Impact Center recruited seven general pediatricians, three developmental-behavioral pediatricians, and one clinical psychiatrist to participate in the focus groups. They also interviewed four general pediatricians and one developmental-behavioral pediatrician who hold national roles to advance early childhood developmental health. The focus groups and interviews, conducted in January and February 2024, followed a list of open-ended questions to allow for flexible, yet guided, discussions.
Questions explored both pediatric practice- and systems-level considerations:
A key theme across focus groups and interviews was the role of trust. Trust-building practices can strengthen early childhood developmental health systems. On the other hand, a lack of trust – either between services or with families – can have detrimental impacts.
Participants frequently highlighted the importance of time with families to build trust and earn their buy-in. Negative perceptions, long wait times, and competing demands can affect how a family engages with the interventions and services recommended to them. When pediatricians have time to build relationships with families, they can better understand how to support them, and families are more likely to trust the system.
Pediatricians often highlighted early relational health as a key way to build trust with families. Early relational health refers to the emotional well-being that develops when babies and toddlers experience strong, nurturing relationships with their parents and caregivers. These positive connections help foster strong relationships between families and providers, too.
This [well-child visit] isn’t a one-time conversation, right? It’s like longitudinally building that trust, building that collaborative discussion little bits by little bits to steer that boat together.
The ECDHS: Evidence to Impact Center identified four key components that can help providers establish and strengthen family trust, including:
Many pediatricians also mentioned similar programs that foster relationships and promote early childhood development, including:
Many pediatricians said the challenges they face come from the broader healthcare system, especially how payment structures and policies affect their work. In particular, the dominant model of healthcare emphasizes diagnosis over prevention, which shapes how pediatricians are trained, how they practice, and how they are compensated. This model does not align well with early childhood care, which largely focuses on prevention and early intervention, making it incompatible with the traditional fee-for-service delivery system. This tension is felt throughout the visit, as payers (the organization that pays for care services administered by a healthcare provider) and administrators may not value the time pediatricians spend with families and engage in developmental promotion.
Some pediatricians also said that the dominant healthcare model can impact young children’s access to services, as some programs have rigid eligibility requirements that require a diagnosis, which may not yet be feasible when working with young children.
Most of them [early childhood conditions] are not medically complex, but they are socially complex. They are developmentally complex, and that complexity is often lost in the way our systems currently operate.
Through this research and technical assistance work, the ECDHS: Evidence to Impact Center has identified ways to strengthen systems and reduce challenges.
The ECDHS: Evidence to Impact Center worked with states and communities to put these recommendations into action. Through technical assistance, they helped states identify policy levers to support strong, high-quality early childhood systems. This work has also reinforced the need for coordination at all levels. For example, although EPSDT is a required Medicaid benefit, many states need support in communicating the policy to payers and ensuring providers understand how to apply the guidance. Similarly, when states successfully establish enhanced reimbursement, they often require support to ensure payers and providers are aware and know how to use them effectively.
The ECDHS: Evidence to Impact Center also supported pediatric practices with embedding early relational health, team-based care, and other family-centered strategies.
