Project DULCE is an innovative pediatric-care-based intervention through which primary care clinical sites proactively address social determinants of health and promote the healthy development of infants from birth to 6 months of age.

DULCE works to prevent and mitigate the impact of toxic stress on young children and their families by strengthening the protective factors (conditions or attributes that help parents find resources, supports, or coping strategies that allow them to parent effectively), addressing social determinants of health, and changing/transforming systems to better support families. DULCE provides these supports based on parents’ needs and priorities with the option of providing home visits, at the parents’ choice.

With parent engagement at its foundation, DULCE draws on and incorporates components of the Medical-Legal Partnership model to ensure that families have access to the resources they need. A Project DULCE Family Specialist (FS) paraprofessional is embedded in the primary care medical home and provides child development anticipatory guidance and connection to concrete supports, including legal guidance, in partnership with a medical legal partner.

The model additionally incorporates curriculum from Brazelton Touchpoints (a practical approach supporting professionals to foster parenting skills and enhance strong family-child relationships laying the foundation for children’s early learning and healthy development); is aligned with the revised Bright Futures, 4th Edition (Guidelines set by the American Academy of Pediatrics to address the care needs of all children); and is a natural transition to Help Me Grow and home visiting programs as appropriate — all while nested in the child’s medical home.


First 5 LA partnered with The Center for the Study of Social Policy (CSSP) to pilot Project DULCE in four clinic sites across L.A. County:

On Feb. 11, 2016 the First 5 LA Commission approved a partnership with the Center for the Study of Social Policy (CSSP) to co-design and launch Project DULCE at three clinic sites in Los Angeles County:

  • The Children’s Clinic in Long Beach
  • Northeast Valley Health Corporation in Sun Valley
  • St. John’s Well Child and Family Center’s clinic in South LA.

Partnership Goals

An interdisciplinary team comprised of a family specialist, medical provider, mental health supervisor, clinic lead, legal partners, and the early childhood lead (First 5 LA) work in partnership to provide support to the newborn and their family through a weekly case conference, monthly continuous quality improvement (CQI), training, reflective supervision, and consultation/referral when needed.

The project’s three outcome goals are:

1. Community Systems: Enhanced partnerships among pediatric health care providers, the medical legal partnership, other community resources and the broader early childhood system.

2. Services:

  • Improved ability to identify families at risk of toxic stress;
  • Improvements achieved without disruption to clinic flow; and
  • Strong patient satisfaction ratings for DULCE services.

3. Families:

  • Increased connection to needed concrete supports and community resources;
  • Increased utilization of well-child/preventive health care visits;
  • Decreased use of emergency room care; and
  • Strong patient satisfaction ratings for DULCE services.

Key Milestones

Family engagement in the CQI process has already led to program design improvement to meet the needs of families.