Stanford Medicine Children’s Health recently developed a new palliative care team designed to help improve access and quality among underserved pediatric populations.

The pediatric palliative team is taking a three-tiered approach to care delivery that includes building collaborative relationships with health care providers across the continuum, according to Dr. Justin Baker, division chief and director of the Division of Quality of Life and Pediatric Palliative Care at Stanford Medicine Children’s Health.

“We’re calling this a palliative paradigm shift and we’re just getting started with it,” Baker told Palliative Care News. “We’re going to horizontally integrate into all sorts of different areas of the hospital, ambulatory clinics and eventually in the home setting. We think about this on three tiers: a console-based model readily accessible to address concerns; a proactive integration model where we partner with other care areas; and [a model] where we activate resources, provide education and develop policies around primary palliative care.”

Launched in October 2023, Stanford Medicine Children’s Health interdisciplinary pediatric palliative team is in its early stages of development. The health system anticipates an average daily census of roughly 60 to 80 patients and roughly 400 to 600 patients annually, according to Baker.

Stanford Medicine Children’s health is among the largest pediatric and obstetric care providers across its service region in California.

The health system operates the Lucile Packard Children’s Hospital Stanford, along with 85 care locations across the San Francisco Bay area and the Pacific region of the United States. Academically affiliated with Stanford Medicine and Stanford University, the health system’s goals include the advancement of multidisciplinary research and education in pediatric medicine.

“A major issue that’s very common is that parents struggle to frequently take off work to care for their sick child at home while balancing all of these other things,” Baker said. “It’s very problematic to navigate the care complexities of their child, their own mental health and household needs and components of issues from a social determinants of health standpoint. The major difference in pediatrics versus the adult side is that you view the family unit as part of the patient care context.”

In addition to launching the model organization-wide, the health system intends to integrate its palliative care team members into departments such as neurology, immunodeficiency and oncology providers, among others, Baker said.

This approach to “embedding” palliative professionals in other units aims to not only reach patients with unmet needs sooner, but also to address staffing issues, Baker indicated. Not enough clinicians are trained in pediatric palliative care, making clinical capacity a delicate balance amid widespread workforce shortages.

“We decided that one of the priorities was going to be to integrate palliative care as part of these providers’ teams to make sure that these patients with the most high-risk diseases,” he said. “We call it our ‘embedding approach.’ It’s making sure everybody is getting better at communication, symptom support and family-centered care and coordination. We’re helping to train and put additional policies and resources behind it.”

Closing disparity gaps among underserved pediatric populations is another goal of the program, Baker stated. The health system is in the process of recruiting a chief health equity officer, a Spanish-speaking interpreter and interdisciplinary team members from diverse backgrounds to help bridge cultural and language divides in underserved communities, he said.

Among the health equity initiatives is to develop a mobile, community-based care team to improve access for patients and families in home settings, particularly those in areas with limited pediatric palliative provider resources, Baker said.

“We know there’s a lot of work to do and we have diversity, equity and inclusion initiatives [to] really try to address these gaps proactively,” Baker said. “We recognize that one of the huge disparity issues is just getting to the clinic or the hospital. So we’re trying to create mobile care teams to get out to those patients and families.”