Objectives: During infancy, the American Academy of Pediatrics Bright Futures fourth edition health supervision guidelines recommend frequent well-child visits (WCVs) in which providers are expected to screen for and address maternal depression, intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach that implements these recommendations (Developmental Understanding and Legal Collaboration for Everyone; DULCE) with 3 aims for 6-month-old infants and their families: 75 receive all WCVs on time, 95 are screened for 7 HRSNs, and 90 of families with concrete supports needs and 75 of families with maternal depression or IPV receive support. Methods: Between January 2017 and July 2018, five DULCE teams (including a community health worker, early childhood system representative, legal partner, clinic administrator, pediatric and behavioral health clinicians) from 3 communities in 2 states participated in a learning collaborative. Teams adapted DULCE using Plan-Do-Study-Act cycles, reported data, and shared learning monthly. Run charts were used to study measures. The main outcome was the percent of infants that received all WCVs on time. Results: The percentage of families who completed all WCVs on time increased from 46 to 65. More than 95 of families were screened for HRSNs, 70 had ≥1 positive screen, and 86 and 71 of those received resource information for concrete supports and maternal depression and IPV, respectively. Conclusions: Quality improvement-supported DULCE expansion increased by 50 the proportion of infants receiving all WCVs on time and reliably identified and addressed families' HRSNs, via integration of existing resources.
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