Member Spotlight: Joan Jeung

Joan Jeung MD MPH FAAP is a Clinical Professor in the Department of Pediatrics, Division of Developmental Medicine at the University of California San Francisco (UCSF) School of Medicine. Dr. Jeung’s research interests center around innovative programs that strengthen behavioral and developmental healthcare capacity in pediatric primary care. Dr. Jeung serves as Senior Associate Director of the Child & Adolescent Mental Health Access Portal (Cal-MAP), the pediatric mental health care access portal for California. She also directs the Resilience Clinic at UCSF Benioff Children’s Hospital Oakland, a primary care-based, caregiver/child group intervention for young children (ages 0-5) exposed to adversity.  

Outside of UCSF, Dr. Jeung serves on the Executive Committee for the American Academy of Pediatrics (AAP) Council on Healthy Mental and Emotional Development (COHMED) and on the AAP Pediatric Mental Healthcare Access National Advisory Group. From 2017-2021, she served on the inaugural executive committee for the Section on Minority Health Equity and Inclusion (SOMHEI).

Questions:

1. What inspires your work in group well-child care?

What inspires me? The possibility of helping children live up to their potential despite adversity by strengthening their relationships with those caring for them. 

I started and previously directed a group well-child care program at my former workplace, a federally qualified health center (FQHC) serving mostly Asian immigrants and refugees.  Funded by an American Academy of Pediatrics (AAP)/HRSA Healthy Tomorrows Partnership for children grant, we developed this program out of a desire to embed parenting support and education in primary care to promote healthy early childhood development but found that voluntary stand-alone parenting groups had limited appeal. Our community health workers advised me that these parent groups needed to be structured as medical appointments, so we decided to re-cast our parent support groups as group well-child care visits. Since we had never actually heard of group well-child care or Centering, we developed our own curriculum using some materials from Nurturing Parenting by Steven Bavolek regarding positive parenting approaches and anticipatory guidance from the American Academy of Pediatrics (AAP) Bright Futures guidelines regarding nutrition/breastfeeding, sleep, colic, and early childhood development. Pediatricians or family practitioners facilitated these groups, along with language-concordant community health workers who provided interpretation as needed. Parents loved the program and the sense of community they felt in the groups; some Chinese mothers created a joint We-Chat group (Chinese social media platform) sharing tips on diaper sales, how to get their kids to eat vegetables, etc., and on their own decided to reunite every year around their children's birthdays. As a pediatrician, I felt closer to the mothers participating in these groups because we got to have much deeper conversations about the topics that matter: post-partum wellness and recognition of depression; recognizing and responding to their infants' cues; the importance of interactive play for healthy development; breastfeeding and healthy age-appropriate nutrition; and positive disciplinary approaches that did not rely on spanking. Qualitative interviews found high satisfaction and parental reports of changed parenting practice. A preliminary analysis of developmental screening data (with the Ages and Stages Questionnaire) suggested that the risk for cognitive developmental delay was lower among GWCC participants. While I'm no longer at this FQHC, I've heard from my former colleagues that the program re-started after a few years' hiatus related to the COVID-19 pandemic. They are making this the default way to receive well-child care in infancy, allowing parents to opt out if they prefer individual care instead. 

Currently, I direct a different family group intervention called the Resilience Clinic at UCSF Benioff Children's Hospital (BCH) Oakland's primary care clinic. The Resilience Clinic is a parent psychoeducational group intervention designed for parents/caregivers of children ages 0-5 years who have been exposed to Adverse Childhood Experiences (ACEs). It was first developed as part of BCH Oakland's work piloting the Pediatric ACEs and Related Life Events (PEARLS) screener for ACE exposure and interventions to mitigate the potential impact of ACEs on child health. A multi-disciplinary team of pediatricians and mental health professionals developed this group intervention out of the need and desire to provide on-site parenting support for children and families found to have positive ACE screening results. I came on in mid-2020 as previous leaders left the organization and COVID-19 (and new funders' priorities) necessitated significant changes to the program's content and format, shifting from serving mostly school-age children in-person towards focusing on children ages 0-5 years on Zoom. We trained all our facilitators in Circle of Security Parenting, an attachment based early childhood intervention with international reach, using their parent-facing videos to help structure parent discussion on connection, the building blocks for attachment and security, tips for regulating big feelings, and recognizing parents' triggers from their own childhood ("ghosts in the nursery", called "Shark Music" in Circle of Security). To this material we added additional content on mindfulness and centering skills developed by Dovetail We Are Resilient to provide parents with tools to support their own stress management. Through a UC ACES Aware Network (UCAAN) PRACTICE grant, we were able to pilot the Resilience Clinic in multiple other pediatric primary care and community-based settings, including a Head Start program and drop-in center for homeless families. A mixed-methods evaluation of the initial pilot was published a few years ago; an evaluation of the redesigned Resilience Clinic as implemented in the PRACTICE grant network was recently submitted and is available in pre-print while awaiting peer review.

2. What areas of research in group well-child care are you most excited about?

There is a term called relational health: The caregiver's capacity to develop and sustain safe, stable and nurturing relationships with children, the kind that buffers stress and promotes healthy mental and emotional development in children. I am most excited about developing, implementing, and evaluating group interventions in primary care that help to promote relational health. I believe that we can do this by building parent communities and providing opportunities for reflection and learning the self-regulation and co-regulation skills that are vital for both parental wellness and child health and development.

3. What are the priorities for the group well-child care field?

I would like to see more research evaluating the impact of group well-child care on child health, developmental, and behavioral outcomes in addition to the exciting impacts that have already been demonstrated, such as timely immunizations. I believe that GWCC also promotes maternal well-being and would love to see more research along those lines.