A Structured Approach to Community Health and Child Advocacy Training: Integrating Goals, Activities, and Competencies

A Structured Approach to Community Health and Child Advocacy Training: Integrating Goals, Activities, and Competencies

addressed by the Sample Activities are included and highlighted next to the Sample Activities. A. Culturally Effective Care Pediatricians must demonstrate skills that result in effective care of children and families from all cultural backgrounds and from diverse communities. 1. Identify and manage cultural attributes, stereotypes, and biases they bring to clinical encounters. 2. Integrate into clinical encounters an understanding of diversity (family composition, gender, age, culture, race, religion, disabilities, sexual orientation, and cultural beliefs and practices) by recognizing and respecting families cultural backgrounds. 3. Identify children, youth, or families who have limited English language proficiency and demonstrate the ability to use professional interpreters and written materials in the family s primary language to maximize communication. 4. Identify, analyze, and describe health disparities, as well as organizational assets and barriers to delivering culturally effective services. 5. Describe and outline quality improvement activities to achieve health care equity. Sample Activity Name: Where do Families Live? (A1, A2) Sample Activity Description: A guided activity with a worksheet to help learners understand the process and local resources available to find shelter/housing. Completion of activities, accurate completion of worksheet and participation in the group debrief. Sample Activity Name: Spanish Radio Show: Ask the Pediatrician (A3, A4) Sample Activity Description: A multimedia educational project that teaches pediatric residents how to create and deliver health education materials that are culturally competent and at a literacy level appropriate for the Latino community. Completion of curriculum Competencies Systems-Based d- based Learning and Improvement Patient Care 2

Competencies B. Child Advocacy Recognizing their unique roles, pediatricians should advocate for the well being of patients, families, and communities. They must develop advocacy skills to address relevant individual, community, and population health issues. 1. Identify and discuss individual, family, and community (local, state and/or national) concerns that impact children s health. 2. Formulate an attainable plan of action in response to a community health need. 3. Identify and describe resources to effectively advocate for the well-being of patients, families and communities. 4. Communicate effectively with community groups and the media. 5. Find and use evidence and data to communicate, educate, affect attitude change, and/or obtain funding to achieve specific health outcomes. 6. Describe and discuss key features of the legislative process, and identify and communicate with key legislators, community leaders, child advocates, and/or agency administrators about child and family health concerns. Sample Activity Name: Legislative Advocacy Training (B1, B2, B3, B6) Sample Activity Description: Training, held in concert with the LEND (Leadership Education in Neurodevelopmental Disabilities) program (a program funded by the Maternal Child Health Bureau in 34 centers across the US). Learners work in multidisciplinary coalitions with allied health professionals and families to learn about the legislative process in New Mexico. Certificate of Completion Sample Activity Name: Senior Project ( B1, B2, B3, B4, B5) Sample Activity Description: Completing a residency Advocacy Project provides residents with an opportunity to apply advocacy skills and lessons learned throughout residency to achieve real life community advocacy. Review and feedback on proposal, progress and presentation. - Based Learning and Improvement -Based Learning and Improvement 3

Competencies C. Medical Home Pediatricians must be able to identify and/or provide a medical home for all children and families under their care. As defined by the American Academy of Pediatrics, medical home is a model for delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. 1. Recognize the family as the principal caregiver and expert in their child s care, the center of strength and support for the child. 2. Identify state and national resources such as Medicaid and WIC, as well as relevant state and local programs and resources that support families and child development. 3. Partner with families and youth to access resources (including health care financing), and coordinate care to meet the special needs of patients with acute and chronic conditions, at home and in the school setting. 4. Collaborate with families and communities to help navigate the health care system, including transition to adult care. 5. Describe and outline quality improvement activities that result in improved access, coordination, continuity, outcomes of care. 6. Identify and access practice tools that support the provision of a medical home, eg. electronic health records, coding, and accreditation standards (such as NCQA). Sample Activity Name: So you need Health Insurance (C2, C3, C4) Sample Activity Description: A guided activity with a worksheet to help learners understand enrollment criteria for different available local insurance plans. Completion of activities, accurate completion of worksheet and participation in the group debrief. Sample Activity Name: Disability Rights Network Module (C2, C4, C5) Sample Activity Description: A module was developed for 3 hours of interactive learning based on the needs of children with disabilities including laws governing entitlements and protections, insurance coverage, medical necessity, transitions, etc. Participation in discussion Systems-Based Systems-Based 4

Competencies D. Special Populations Pediatricians must be competent in the care of children in special populations, including (but not limited to) children and youth in substitute care, homeless children and youth, children and youth with chronic conditions, immigrants and refugees, and children and youth who are adopted. 1. Identify youth at risk for poor health outcomes and/or with special health care needs; identify the special populations that exist in a community. 2. Screen for risks specific to defined special populations. 3. Demonstrate a working knowledge of psychosocial issues, legal protections, policies, and services provided for these populations at the local, state, and federal levels. Sample Activity Name: Education law Center Module (D1, D3) Sample Activity Description: In coordination with the Development clinical rotation, interns are afforded the opportunity to learn about issues for children with special health care needs. Participation in discussion Sample Activity Name: Family Court with Support Center for Child Advocates (D2, D3) Sample Activity Description: In coordination with the Adolescent clinical rotation, PL2s are afforded the opportunity to learn about issues for dependent and adjudicated youth. A module was developed to support residents while visiting family court. participation and debriefing System-Based Medical Knowledge System-Based Patient Care 5

Sample Activity Name: Individual year long project w community based organizations (E1,E2) E. Pediatrician as a Consultant/Collaborative Leader/Partner Pediatricians must be able to act as child health consultants in their communities. Using collaborative skills, they must be able to work with multidisciplinary teams, community members, educators, and representatives from community organizations and legislative bodies. 1. Identify potential opportunities to serve as a health consultant in the community where he/she practices pediatrics and demonstrate the ability to communicate effectively with a variety of audiences within that community. 2. Describe and discuss the essential qualities of community partnerships including shared vision, the use of complementary strengths, the willingness to collaborate, and the development of agreed-on boundaries. 3. Define and discuss principles of consensus building, including fostering inclusiveness, identifying mutual goals, setting measurable outcomes, using effective problemsolving strategies and negotiating towards consensus. Sample Activity Description: Each intern class partners with large, community based organizations or school district to create sustained capacity in underserved communities. Poster presentations, grant project section, project products, narrative reflection, community feedback Sample Activity Name: Media engagement (E2, E3) Sample Activity Description: At the beginning of the outpatient adolescent rotation residents meet with faculty where an overview of the role of the physician in the media is explored. Catalogue of letters sent, published, topics addressed, completed worksheet, narrative reflection Competencies 6

Sample Activity Name: Community presentations/community Q&As (F3) F. Educational and Child Care Settings Pediatricians must be able to interact with staff in schools and child care settings to improve the health and educational environments for children. 1. Promote the children s health and success in school by assessing children for school readiness, making appropriate referrals to relevant community services, and communicating and collaborating with school nurses, teachers and administration. 2. Explain how to work with families, educational, and child care institutions to help provide optimal learning environments for all children. This includes knowledge about high quality early education, the Individuals with Disabilities Education Act, participation in Individualized Education Plans and Individual Family Service Plans, and provision of medications and/or medical care in school settings 3. Describe and discuss how a physician can collaborate to improve the physical, social, and health environment in schools and child care settings. Sample Activity Description: During the community pediatrics rotation residents make presentations to parents and/or children on a variety of child health topics. Rotation coordinators work with existing community partners to schedule residents for various health talks. Narrative reflection, pre/post assessment, Grand Rounds presentations Sample Activity Name: Meet w/schools, Head Start, Early Head Start, WIC, local homeless shelter, and other CBOs (F1, F2, F3) Sample Activity Description: Residents have site visits to meet with the leaders of various community and county based organizations to learn about their mission and services Summary document of groups priorities and assets, grant background, narrative reflection, community evaluation of residents Additional Sample Activities Competencies Medical Knowledge Patient Care System-Based 7

Competencies G. Public Health & Prevention Pediatricians must be able to practice from a population based perspective and understand relationships between individual, family, and community-level health determinants that affect children and families in the communities they serve. Pediatricians must be able to apply community assets and resources to prevent illness, injury, and death. 1. Describe and discuss modifiable risk factors and the evolving epidemiology of pediatric illnesses and their impact on child health and well-being and child health equity. 2. Identify and discuss child health issues at the national, state, and local levels by accessing and using vital statistics, surveillance data, community asset mapping, and other sources of data. 3. Identify measurable outcomes for assessing progress in addressing child health issues, including health equity. 4. Identify and describe effective public health interventions at the individual, community, and national level, e.g. screening & prevention programs aimed at modifying risk factors for disease or adverse health outcomes, and case identification and tracking. 5. Describe and discuss the individual practitioner s role within the greater public health infrastructure, including early identification, notification, mandated reporting, and emergency planning/response recovery. Sample Activity Name: Demographics Exercise (G1, G2, G3) Sample Activity Description: A self-directed exercise to study the community and public/social factors that may influence the health risk of patients and families in residents community practice. Worksheet is submitted, reviewed, feedback provided and becomes part of individual resident portfolio Sample Activity Name: Child Death/Non- Homicide Review Team (G2, G3, G4) Sample Activity Description: PL2s are invited to participate in a multi-disciplinary city health department review of child deaths. reflection and debriefing System-Based Medical Knowledge Medical Knowledge 8

Competencies H. Inquiry and Application Pediatricians should be capable of pursuing inquiry that advances the health of children, families, and communities. 1. Assess and apply evidence-based practices for children and families relevant to the needs and resources of their communities. 2. Discuss how quality improvement assessments and methodology can be integrated into interactions with community organizations serving children and families. 3. Describe and discuss the ethical issues that relate to research and scholarship in communities. 4. Describe and discuss different methodologies of research in communities, including community-based participatory research. Sample Activity Name: CATCH grant (H2, H3) Sample Activity Description: Each resident completes an AAP CATCH grant application for an advocacy proposal they have developed. Completed CATCH grant application in portfolio Sample Activity Name: Advocacy Journal Club (H1, H2, H3, H4, H5) Sample Activity Description: PL3s during their senior advocacy rotation choose a journal article to present during morning report that relates to a child advocacy issue. They have an assigned mentor for guidance and are encouraged to invite faculty experts in the field for discussion. presentation at morning report and faculty feedback - Based Learning and Improvement System Based Medical Knowledge The educational goals and objectives are based on the community pediatrics competencies published in Pediatrics. Rezet, B., Risko, W., & Blaschke, G.S., (2005).Competency in Community Pediatrics: Consensus Statement of the Dyson Initiative Curriculum Committee. Pediatrics, 115: 1172-1183. 9