Pediatrician urges continued funding for DULCE family-support program amid Blueprint pilot gap

Brenna Holmes, a general pediatrician and president of the American Academy of Pediatrics' Vermont chapter, told the House Healthcare Committee the DULCE (Developmental Understanding and Legal Collaboration for Everyone) model supports new families and should be sustained as the Blueprint expansion pilot faces a funding gap.

Holmes said DULCE — a practice that embeds a family specialist from parent-child centers and a legal consultant into pediatric primary care — has operated in Vermont since February 2016 and currently reaches nine practices, six of which were supported by the Blueprint expansion pilot and three by federal grants.

The committee heard that DULCE identifies unmet social needs — housing, food and connection — at the start of a child's life and connects families to resources during routine well visits. Holmes said national evidence shows DULCE participants make fewer emergency department visits and have higher rates of preventive care and immunization.

"This is why I became a pediatrician, to address the things that really matter for families and children. And through DULCE, I can," Holmes said. She also relayed a family testimonial quoted to her: "This program's made me feel safe, heard, supported in every way. Our family now has the opportunity to thrive in the face of chaos."

Holmes described how the model is implemented: parent-child centers employ the family specialists, who work full time in the medical practice to do screening, care teaming and referrals; a legal aid attorney provides consultative case review to the team (not direct legal representation to families); and a university-based quality improvement team reviews practice data monthly.

Committee members asked for concrete budget numbers and site locations. Holmes said she would provide suggested funding amounts and said a submitted packet includes a map of the nine sites and links to evaluation data. She also told the committee that the Blueprint pilot had been implemented through Medicaid and that the state is now navigating a gap year related to Vermont's AHEAD model transition; as a result, money used for the pilot this year is being applied to cover that gap rather than continuing DULCE funding.

Holmes gave several program details to the committee: Vermont has roughly 5,000 births per year, DULCE participation rates in participating practices have approached 98 percent of infants seen in those practices, and the model leverages blended funding sources (federal grants, Blueprint support and historical contributions from organizations such as OneCare ACO).

Committee members and Holmes noted the committee will see additional data and testimony the next day; Holmes said Blueprint had been asked to send program data and that Jessa Barnard would present further details.

No formal vote or funding decision occurred during the session; Holmes agreed to provide requested budget figures and site information to the committee for its consideration.

Holmes closed by urging continued investment in primary prevention in pediatric care, saying the model improves clinician work life and can reduce longer-term health costs by preventing crises early in a child's life.