Five Pillars of Solid Start

We will focus on the following five strategies to achieve Solid Start’s vision for improved care for pregnant women and young families at ZFSG.

Universal Assessment and Referral

A universal needs assessment and point-of-care resource referral eliminates many of the structural silos resulting from initiating programs in specific departments.

ZSFG Children’s Health Center is home to a very successful family navigation program—the ZSFG Health Advocates—that offers assessments of families’ social, financial and medical needs and then links families with relevant hospital and community resources. We have been convening ZSFG mental health stakeholders to provide input on expanding the current Health Advocate screening tool to include enhanced mental health screening. A pilot with enhanced mental health screening and mental health supports will begin in the Women’s Health Center in June 2016.

Palette of Programs

Although ZSFG has a number of excellent programs such as the Infant-Parent Program, Centering Pregnancy and the Child Research Trauma Program, many programs serve only very high risk women/families or are limited pilot programs. The goal of Solid Start is to identify the most successful of these internal programs and support and expand them to serve all ZSFG pregnant women and young families. Additionally, Solid Start will continue to partner with related community programs to strengthen the web of parenting support, medical and mental health services, and social resources available to ZSFG families.

In fall 2015, we created the first comprehensive ZSFG program guide documenting the broad and deep array of ZSFG program resources focused on pregnant women and young families. We have completed interviews with program leads across ZSFG to gather details on all relevant hospital and community programs. The information on program services, eligibility, referral procedures and contacts is available on the Solid Start website ( for all interested providers. This is a working, living document that will be updated based on program operations.

Technology Platform

A second Solid Start pillar involves the development or acquisition of a technology platform that enables medical and social service providers to identify the needs of low-income families and to connect and refer those families to appropriate resources both inside and outside of the hospital. Currently, ZSFG providers have no comprehensive social screening tool embedded in the Electronic Health Record (EHR), no consistent or automated mechanism for matching patient needs with available programs or resources, no computerized secure communication mechanisms between hospital and community social programs, and no systematic hospital follow-up or data tracking on social needs.

These gaps are not unique to ZSFG. Across the country, safety-net providers struggle to communicate effectively across social, behavioral health and medical services to improve care for vulnerable populations. Yet new technology platforms, both those embedded in EHRs and those that operate in partnership with EHRs, offer new opportunities to advance these communications.

The Solid Start Working Group has identified four key components for an ideal Solid Start technology platform: screening, case management, data tracking and automated referrals. We have conducted interviews with seven companies that offer platforms to support the integration of social services with medical care delivery.

Family Resource Center

Solid Start also plans to develop a welcoming space for families to gather while at the hospital and to house the administration of Solid Start. Given limited clinical space, this Solid Start Family Center will be a place families can meet with program staff for services or to learn about other resources. We will have an opportunity to create this space in the existing hospital building once the new hospital opens and are currently working on design plans.

Provider Education

For Solid Start to be effective, providers must understand the social constructs of health and recommend Solid Start services to their patients. Because ZSFG is a training hospital, we have an opportunity to train a cadre of people who can advocate for social support programs in their future communities as well. Solid Start will work closely with the Zuckerberg SFGH Training and Education Programs for Underserved Populations (STEP UP) a joint effort across ZSFG-based residency programs focused on improving underserved care. Solid Start will collaboratively develop STEP UP activities on topics relevant to pregnant women and families with young children, including Grand Rounds and other learning activities.