Advocacy Project Proposal by ljp20798

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									Pediatric Academic Societies’ Annual Meeting
  Advocacy Training Initiative Mini Course

              Resident Abstracts
        Platform and Poster Presentations

                 April 29, 2006
                                  Table of Contents

1………… Pilot Project Proposal: Training Community Health Workers to Provide Treatment of
      HIV in rural Botswana
         Jennifer Achilles, MD

2………….A Peer-Educator Safety Program at a Native American Health Center
        H. Ackley, MD, J. Yeh MD, A. Kuo MD

3………….Young Doctors Club and Mentorship Program
         Kristin Anderson, MD, Sybil Cineas, MD

4………….CHARGE: Children’s Health, Activity, and Resources for Growth and
        Marc Auerbach, MD, Cindy Osman, MD

5………….A literacy intervention for children of pregnant adolescents
         Naomi Bardach, MD, Jane E. Anderson, MD

6………….The Zia Bike Project
        Galen Barnes, MD, Benjamin Hoffman MD, Paul Avritt MD

7…………..Infants of Teen Parents: Improving Access to Care
         Shrena Patel MD, Sara Bluefeather, Mona Shah MD, Benjamin Hoffman MD

8…………..Advocacy for Disadvantaged Children- It s Time to Camp!
         Matthew Broom, MD , Scott Keller, MD, Elizabeth Montgomery, MD

9………….The CHOP Homeless Health Initiative: Resident-driven Advocacy Training
        Nadia Dowshen, MD, Halden Fitzgerald, MD,, Beth Rezet, MD

10…………Interdisciplinary Advocacy: Community Leadership and Resident Education in Oral
         Kristen Eisenman, MD, Michele N. Lossius, and Maureen Novak, MD

11…………Ballroom Dance for LIFE: A Unique Approach to Urban Physical Activity and
        Evan Fieldston, MD, Megan Aylor, MD, Carmen Baccarini, MD, Christina
        DiNicola, MD, Jessica Kutikov, MD), Jennifer Melnychuk, MD, Audrey Park,
        MD, Rakhee Patel, MD, Jennifer Rothman, MD, Susmita Pati, MD

12…………A Collaboration to Provide Back-to-School Vaccines
        A.Gehle, MD, G. DeAngelis MD, S. Jeng MD, C. Nosek, A. Turner, AK. Kuo MD

13…………Military community needs assessment of orphans and vulnerable children (OVC) in
      South Africa
        Katrina Gray, MD, Linnea Axman MD

14………….Homeless children and Medicaid HMOs
        Cori Green, MD, Beth Volin, MD, Molly Martin, MD, Priti Jani, MS, Margaret
        Scotellaro, MD

15…………Advocacy for the Poor: an elective pediatric residency rotation
        Marsha R. Griffin MD, Javier Kane, MD, Joseph B. McCormick MD

16…………Reach Out and Read: A Resident-Driven Statewide Expansion
        Emily A. Hannon MD, Stacey Townsend MD, Angelika Valdez MD, Wendy
       Hobson, MD

17…………Curbing Obesity in Partnership with School-Based Health Centers: The Cincinnati
      Children’s Experience
        Melissa Keene, MD, Ryan M. Buchholz, MD, Stephen E. Wilson, MD, Caroline V.
        Mueller, MD

18…………Reducing Health Disparities: Residents partnering with Schools and the community
      to optimize asthma care
         Kate Leonard MD, María Cecilia Mosquera MD, Lisa Chamberlain MD, Laurie
         Bauer MD, Janine Bishop MD

19…………Resident physicians’ knowledge and attitudes about health disparities
        R. Manchanda, MD, H. Fernandez MD, A Kuo MD, MF Shapiro MD

20…………Are We Training Advocates? Perceptions and Experiences of Patient Advocacy
      from Fourth Year Medical Students
         Maireade McSweeney, MD, Wayne LaMorte, MD, Megan Sandel, MD, Lauren
         Smith, MD

21…………A Prospective Study of Deaf Community Assess to Health Care
        Wendy Osterling, MD, Karen Buchi, MD and Wendy Hobson, MD

22…………Diaper Duty
        Diane Pappas, MD, John Mytinger, MD

23………….Improving Health Literacy with a DVD of Anticipatory Guidance Tips
         Heather Paradis, M.D, Neil Herendeen, MD, C.Andrew Aligne, MD

24………...“You smoke you will choke”: Evaluating a 4th-5th grade school-based smoking
         prevention curriculum
           Sarah Pitts MD, Dmitry Dukhovny MD, Lisa Roy MD, Emily Willner, Justin
           Linam BA, Wanessa Risko MD, Romi A.Webster MD

25…………Barriers Towards Breastfeeding Among African American Women: A Community
      Analysis for Intervention
        Gisela Porras, MD, Colleen Kalynych, MSH, Matthew Benson, MD, Liberty
        Dizon MD, Edessa Jobli, MPH, Ru-Jeng Teng, MD

26…………Expanding the Safety Net: Public Insurance for Adolescents after their 18th
       Joshua Rising, MD, Ellen Kaiser, RN, MHA, Elena Fuentes-Afflick, MD,
       Mitch Katz, MD

27…………ACTing Together: Resident Advocacy in a Primary Care Clinic
       Lisa Roy MD, Lisa Swartz MD, Justin Linam MM, Emily J. Roth MD, Romi A.
       Webster MD

28………….Mobile Medical Home for Children in Foster Care
        Monica Stoffer, MD, Alice Kuo MD

29…………“Creating a Mentoring and Advocacy Project for Incarcerated Native American
       Youth in a State Juvenile Justice Facility”
        Yolandra Gomez Toya, MD, Tassy Parker PhD, Gayle Dine Chacon MD,

30………….The Period of Purple Crying: A Resident Advocacy Project to Reduce the Incidence
       of Shaken Baby Syndrome”
         Hillary Tuttle, MD, Cynthia L. Ferrell, MD
31…………Interdisciplinary Advocacy: Community Leadership and Resident Education in Oral
         Michele Lossius, Kristen M. Eisenman, MD, Maureen Novak, MD

32…………Counseling the Breastfeeding Teen Mother: What Challenges Do Providers Face?
       Carolyn Y. Jacobs Parks, MD, Nancy Chin, PhD

33………….Metal Health in Elementary Schools
        Dzung Vo MD, Betty Chapin MD, Donna Goff MD, Tina Hermos MD, Liana
        McCabe MD, Anda Kuo MD

34………….Downsizing Childhood Obesity
        Beau C. Weill, M.D

35…………Child Passenger Safety (CPS): A Resident’s Responsibility
        Kristi Williams, MD, M. Denise Dowd, MD, MPH

Title: Pilot Project Proposal: Training Community Health Workers to Provide Treatment of HIV
in rural Botswana

Authors: Jennifer Achilles, MD

Timeline: 6-month pilot project in rural Botswana

Target Audience: HIV+ Africans who do not yet have access to HIV treatment.

To improve access to antiretroviral (ARVs) for those living with HIV/AIDS in Africa.

Demonstrate through a 6-month pilot project that directly observed therapy is a viable option for
the treatment of HIV/AIDS in rural Botswana.

Hire and train five community health workers (CHWs) to provide directly observed therapy
(DOT) to five patients each. We will use an existing curriculum developed by Partners in Health.
CHWs will undergo basic training in AIDS care, to include medication adherence, side effects,
recognition of serious infections, and prevention education. They will also provide psychosocial
support, assess the needs of other family members, such as access to school for children,
nutrition, etc. CHWs will be the backbone of this project. They will be trusted members of the
community who speak the local language and know the customs. They understand better than
anyone what it is like to be on ARV medications. They will not only provide medical support
and report back to doctors and nurses in near by clinics, they will also provide the equally
essential emotional support, in a place where AIDS patients are still stigmatized and
discriminated against.

Outcome Measures:
Compare weight gain, CD4 count, viral load, and medication adherence at project entry and at 6

Lessons learned in implementation:
It is difficult to obtain national level approval for a project unless you are living in the country.

Title: A Peer-Educator Safety Program at a Native American Health Center

Authors: H Ackley1 (PGY-3), J Yeh2 (MSIII), AK Kuo1 (Assistant Clinical Professor).

Department of Pediatrics1, School of Medicine2, University of California San Francisco.

Unintentional injury rates among Native American youth are substantially higher than other
American youth.

1) Conduct a needs assessment of safety awareness in the Native American Health Center
(NAHC) community in Oakland, CA.
2) Train peer educators (PEs) at NAHC to disseminate safety information to the community.

An IRB approved survey was distributed to youth and adults at the NAHC to assess community
knowledge around safety. We developed a safety curriculum for PEs who were recruited and
trained to educate the community.

We report a sample of the survey information. Forty-nine adults completed surveys with 53%
stating that their children always wore bike helmets. Of the 32 children, 63% reported always
wearing a seatbelt and 10% reported always wearing bike helmets.

Eleven peer educators participated in 8 training seminars. The PEs then designed and conducted
interactive seminars for 20 community youth. Topics included motor safety, recreation safety,
emergency preparedness, home safety, water safety, and wilderness safety. The youth were
trained to discuss safety with their families and distributed home safety checklists.

PEs stated that they learned a lot, and 7/11 felt that the peer education strategy worked to relay
safety messages to other children. Some specific comments included, “Some kids listen more to
kids their age [than] to their parents,” and “youth like to listen to youth.”

Preventable injury is an important issue in the Native American community. The NAHC safety
project empowers local youth to educate their community about emergency preparedness and

Title: Young Doctors Club and Mentorship Program

Authors: Resident: Kristin Anderson, MD, Med-Peds PGY-4
         Faculty Advisor: Sybil Cineas, MD

Brown/Hasbro Children’s Hospital and Rhode Island Hospital

The Young Doctors Club (YDC) is a program created in 2003 within the existing partnership
between Rhode Island Hospital (RIH) and Roger Williams Middle School (RWMS). In 2004 the
Young Doctors Mentorship Program (YDMP) was created. This program was an extension of
the Young Doctors Club and involves the neighboring Health Science and Technology Academy
(HSTA) and Brown Medical students. This year the programs welcomed Brown University pre-
medical students who help facilitate sessions.

Target Audience:
The participants include middle and high school students from inner city Providence.

The YDC provides eighth graders with the opportunity to see firsthand what being a doctor
entails while teaching a wide variety of medical conditions with a primary focus on prevention.
The high school students in the YDMP discuss career planning and learn presentation skills
which they utilize during mentoring sessions with the eighth graders.

Biweekly sessions held at RIH during the academic year involve didactics led by residents and
experiences with health care workers. Annual activities include a White Coat Ceremony, a
student run health fair, and a Job Shadow Day.

Outcome Measures:
A survey to be administered at the onset and conclusion of the academic year will assess interest
in the programs as well as any impact participation had on lifestyle behaviors and future goals.
A database to be developed of former and current middle and high school participants will track
their educational and career paths.

Lessons Learned in Implementation:
Challenges include limited funding of after school programs, and learning to coordinate between
community partners.

Title: CHARGE: Children’s Health, Activity, and Resources for Growth and Empowerment

Authors: Marc Auerbach, MD Faculty Mentor: Cindy Osman, MD

Program Timeline: Initiated in September 2002 and is ongoing.

Target Audience:
3rd-5th graders at NYC PS 51, serving a poor, ethnically diverse community. Family members
are educated through evening programs and a health fair. Pediatric residents participate during
their clinic rotation.

Goals and Objectives:
To promote healthier lifestyle choices through education of children and their families. To
increase the knowledge and skills of residents in educating students in a classroom.

Activities occur weekly at the after-school program. Sessions start with an urban appropriate
exercise routine that has been developed by our students, requires minimal space, and can be
performed in a city apartment. A healthy snack is distributed. A didactic introduces the week’s
topic and reviews prior topics. Group activities provide reinforcement. Topics are: food groups,
food choices, vitamins and minerals, food as energy, exercise and energy usage, understanding
fats, and label reading. Additional lesson plans include: violence prevention, hand washing and
cleanliness, injury prevention, stress relief, summer safety, and smoking prevention. Evening
parent education sessions and a health fair reinforce the lessons. The fair involved distribution of
helmets and protective gear, parent and grandparent health screenings, and a “healthy food fair.”

Outcome Measures:
There was poor compliance with a parent survey. The students displayed good retention on
weekly reviews of prior topics and report compliance with the aerobic fitness routine on non-
class days. A food and exercise diary shows a minimal effect of our program on daily habits.

Lessons learned in the implementation of the project:
As the program progressed we made the didactic sessions more brief and focused. We learned
that providing frequent reinforcement of prior topics led to improved retention.

Title: A literacy intervention for children of pregnant adolescents

Authors: Naomi Bardach, MD (PGY3), Jane E. Anderson, MD

Department of Pediatrics, University of California, San Francisco (UCSF)

Babies born to adolescent mothers are at risk of having poor literacy outcomes. The Mt Zion
Young Women’s clinic (ZYW) in SF, CA has a large population of pregnant adolescents and no
literacy intervention ongoing in the clinic. The literacy levels, literacy orientation, and perceived
barriers to literacy in this population are unknown.

To assess ZYW patients’ reactions to a literacy intervention, as well as their levels of literacy,
literacy orientation, and perceived barriers to improving their own and their children’s literacy.

During October 2005-April 2006, a video promoting literacy skills for parents was shown in the
waiting room of the clinic. Pregnant young women (ages 13-21) at the clinic for prenatal care
who were exposed to the video were enrolled by convenience sampling. They were then
interviewed and given the REALM literacy test by a study investigator. They also received a
free infant book and were offered adult literacy resources. Demographic information was
gathered from the medical chart. The study has IRB approval.

Data collection is ongoing. Available April data: Total number of subjects and demographics;
Response to video, literacy levels, literacy orientation, and perceived barriers to literacy in the
interviewed clinic population.

Conclusions: Pending.

Title: The Zia Bike Project

Authors: Galen Barnes, MD, PGY-2, Benjamin Hoffman MD, University of New Mexico
Department of Pediatrics; Paul Avritt MD, Albuquerque Indian Health Service.

Timeline: The Zia Bike Project was established in 2004.

Target audience:
The Pueblo of Zia lies 35 miles Northwest of Albuquerque, NM. Obesity among children and
adolescents is a significant concern to tribal leaders and health care providers on this poor, rural

Goals and Objectives:
The goal of the Zia Bike Project is to combat obesity among the youth of the Zia pueblo through
an educational, nutrition and fitness campaign coupled with the development of a bicycle club
designed to promote a healthy lifestyle and physical fitness.

We will travel to the Zia Pueblo monthly to work with children, adolescents and their parents to
help teach them about making better choices for themselves and their children to combat obesity
using a family centered approach. Topics will include health, nutrition and physical activity.

A youth bicycle club has been created to improve physical activity. The club ensures that all
children have functioning bicycles and helmets, and that they are safe and able to take care of
themselves and their bicycles while riding. Skills in bicycle maintenance, safety, riding
techniques, and first aid are taught on a regular basis. Consultants and volunteers from local
bicycle shops have been enlisted to assist.

Permission from the Governor of the Zia Pueblo to build both a mountain bike trail system as
well as a BMX park with moguls, ramps, etc. has already been obtained.

Outcome Measures/Lessons Learned:
The progress of the children and the program will be measured by tracking BMI data and riding
logs for all participants. Attitudes toward physical fitness and the importance of a healthy
lifestyle will be surveyed for both youth and parents. The program won a Resident CATCH grant
in 2004.

Title: Infants of Teen Parents: Improving Access to Care

Authors: Shrena Patel MD, Sara Bluefeather MD, Mona Shah MD, Benjamin Hoffman MD

University of New Mexico School of Medicine Department of Pediatrics

New Futures is an alternative high school in Albuquerque, NM for pregnant and parenting
teenagers. New Futures enrolls 300 students and has daycare for 110 children of students. We
have established an onsite well child clinic to provide routine well child checks, vaccinations and
anticipatory guidance to the young children of the school’s students.

The student body is a low income, primarily Hispanic, urban population. There are significant
barriers to care for this population, including transportation and significant financial constraints.
Additionally, these parents are full time students managing the challenges of high school.

In 2004, UNM house staff received a Resident CATCH Planning Grant and have created and
sustained a school-based well-child clinic at New Futures. The residents work collaboratively
with nursing staff, developmental specialists, faculty from the Children’s Hospital of New
Mexico, and the staff of New Futures. We have consistently provided care one half day per
month through 3 generations of house staff, creating a medical home for these high-risk infants.

The primary outcome measure has been clinic utilization. We currently have a panel of 40
patients, aged 6 weeks to 3 years old. We have had many frustrations assuring a sustainable
revenue source for our clinic. All of our patients are Medicaid dependent, and enrolling and re-
enrolling our patients in Medicaid has been a particular challenge.

We have applied for further funding, and are currently working with state Medicaid resources to
improve access for our patients. We continue to strive to develop a sustainable medical home
within this school for its unique student body. We are working at becoming an integral part of
the school.

Title: Advocacy for Disadvantaged Children- It s Time to Camp!

Authors: Matthew Broom, MD 1 (PL3), Scott Keller, MD1 (PL2) and Elizabeth Montgomery,
MD 1.

Department of Pediatrics, Saint Louis University School of Medicine

Camping has long been recognized as a positive experience for youth. There is a growing trend
towards sending medically, behaviorally or developmentally disadvantaged children into
conventional camping experiences. Camping teaches social skills and responsibility in a safe
environment, provides leadership training and enhances communication skills2,3. There has been
an accumulation of anecdotal and evidence-based literature in support of camping experiences
for youth with special needs—noting improved disease understanding, treatment compliance,
self-esteem and lifestyle enhancement1,4. As advocates, residents should be involved in the
development of their patients, including the creation of new and exciting opportunities.

Enlist and empower pediatric residents/faculty as advocates in the creation of a camping
scholarship to help disadvantaged youth take part in a yearly camping experience.

Data was collected on regional camps that offer specific opportunities for children with special
needs. The benefits of pediatric camping were presented via a department-wide conference and
email. Residents/faculty were challenged to nominate patients to be eligible for receipt of a
scholarship, and to donate towards its funding.

Resident/faculty participation allowed for several scholarships, enabling a few youth to benefit
from individualized camping experiences.

The evolution of camping and its many benefits has led the medical community to take stock in
the value of disease-oriented experiences for disadvantaged youth. Traditional camping
environments for youth with disabilities have been shown to be of benefit in regards to improved
self-esteem, disease awareness and treatment compliance. Our department created an annual
scholarship to address this need.

1. Blau H, et al. Effects of an intensive 4-week summer camp on cystic fibrosis: pulmonary
     function, exercise tolerance and nutrition. Chest 2002; 121(4): 1117-22.
2. Briery B and Rabian B. Psychosocial changes associated with participation in a pediatric
     summer camp. J Pediatr Psychol 1999; 24(2): 183-90.
3. Carpenter PJ, et al. Use of a camp setting to provide medical information to siblings of
     pediatric cancer patients. J Cancer Educ 1990; 5(1): 21-6.
4. Sorrells VD, et al. The impact of a summer asthma camp experience on asthma education
     and morbidity in children. J Fam Pract 1995; 41(5): 465-8.

Title: The CHOP Homeless Health Initiative: Resident-driven Advocacy Training.

Authors: Nadia Dowshen, MD (PL-2), Halden Fitzgerald, MD (PL-2), Beth Rezet, MD

Sponsorship: Beth Rezet, MD; Children’s Hospital of Philadelphia

Department of Pediatrics, The Children's Hospital of Philadelphia

Homeless children represent one of the most vulnerable and underserved pediatric populations.
Children living in shelters are more likely to lack preventive care, and suffer from chronic
disease, poor nutritional status, and behavioral and developmental problems. In order to advocate
for and meet the health care needs of these youth, pediatricians must first be aware of the specific
health issues of homeless children and adolescents.

To provide knowledge and skills for Pediatricians in order to serve and advocate for homeless
children and their families in the health care setting.

Working with community liaisons, a multi-disciplinary team of CHOP pediatric and dental
residents, nurses and medical students visit three area shelters monthly to provide acute medical
care, medical and dental screening, health education and referral to primary and specialty care
services. Previously only a volunteer experience, HHI has been incorporated into the Advocacy
and Primary Care rotation curricula. Several senior resident advocacy projects have focused on
both pediatric resident and shelter participants.

Now in its 18th year, HHI served over 200 children and their families in the last year. A survey
of pediatric resident participants confirms that HHI provides a meaningful experience for future
pediatricians. A recent award from one of the HHI shelters acknowledged that the program is
respected and appreciated by our community partners and the families we serve.

As HHI continues to grow and evolve, it serves as an example of resident-driven advocacy
training that prepares future pediatricians to partner with their communities to address the health
care needs of our most vulnerable children.

Title: Interdisciplinary Advocacy: Community Leadership and Resident Education in Oral

Authors: Kristen M. Eisenman, PL-3, Michele N. Lossius, PL-3, and Maureen Novak, MD.

Pediatrics, University of Florida

In the spring of 2005, the primary care lecture series included a lecture from the UF Pediatric
Division of the College of Dentistry. The lecture highlighted the current state of oral health in
children, access concerns, and the Surgeon General’s “Call to Action.” At that time two
residents were embarking on continuity clinic quality improvement projects, completing
advocacy rotations, and the CATCH cycle was starting.

Apply skills obtained in various domains to improving health care, learn the grant process,
complete and apply quality improvement projects in clinic, form lasting interdisciplinary
partnerships to ensure continuing support and outreach.

Dental caries are the most prevalent infectious and chronic disease in children. Poor and
minority children suffer twice as much dental caries due to lack of access. Knowing that topical
fluoride reduces dental caries 20-40% and that the cost of treating early childhood caries are
profound, the project sought to 1) educate pediatric residents about oral health pathology, dental
screening, and fluoride varnish application 2) provide bi-annual oral exams by pediatric residents
to a target population 3) apply topical fluoride varnish bi-annually to children ages 1-2 years at
well child checks 4) establish local community partnerships 5) petition Florida legislature for
future funding of the implementation of the project locally and statewide

Education of all UF pediatric residents via an online course for oral health education and fluoride
varnish application, incorporation of knowledge of community needs and evidence-based
medicine into a grant proposal, application for a CATCH grant, formation of partnerships with
the UF College of Dentistry and pre-dental undergraduate students, assessment of parental
understanding of appropriate dental health care, application of fluoride varnish bi-annually to 1-2
year old children at their well child checks, provision of appropriate dental referrals to local
pediatric providers to create a dental home.

Residents are successfully incorporation oral health education, risk assessment, and fluoride
varnish application into well child checks at three continuity clinic sites. Interdisciplinary
partners have been established and residents are pursuing different avenues for project

Title: Ballroom Dance for LIFE: A Unique Approach to Urban Physical Activity and Health

Authors: Evan Fieldston, MD, MBA (PL-3), Megan Aylor, MD, Carmen Baccarini, MD (PL-3),
Christina DiNicola, MD (PL-3), Jessica Kutikov, MD (PL-3), Jennifer Melnychuk, MD (PL-3),
Audrey Park, MD, PhD (PL-3), (PL-3), Rakhee Patel, MD (PL-3), Jennifer Rothman, MD (PL-
3), Susmita Pati, MD, MPH (faculty mentor)

Philadelphia’s childhood population has high rates of obesity, lack of structured physical
activity, and need for health education. Inspired by a New York City program with ballroom
dance in schools, we set out to bring this nontraditional exercise format to students. We also
coupled it with health education by pediatric residents. We have targeted third-graders from an
ethnically diverse, lower socioeconomic, inner-city school and are working to expand the
program in future years.

The Ballroom Dance for LIFE (Living Intelligently with Food and Exercise) program seeks to
promote cooperation and self-confidence in youth. Its goal is to promote physical activity, teach
school children about healthy living, foster interactions among children of various backgrounds,
and nurture an appreciation for dance and music. Pediatric residents will have the opportunity to
longitudinally follow children in their school environment.

A team of residents, ballroom dance instructor, and school were recruited in fall 2005. A
curriculum of health lessons was developed. Funding sources were targeted, including an AAP
CATCH Grant and the resident’s home institutions office of Community Relations. In January,
weekly lessons began. The ballroom dance instructor is joined by 1-2 residents each week. A
short health lesson (i.e. smart eating) is provided and then the remainder of the session is devoted
to ballroom dance instruction. City and hospital partners dealing with fitness and obesity are
involved or being invited to participate in the program.

After just 5 weeks of instruction, the students have shown wonderful progress. They enjoy the
health lessons and have written thank you notes expressing their appreciation for all aspects of
the program. Residents are thrilled with it. Several other schools are eager to join.

Bringing ballroom dance with resident teaching of health topics to public schools in a deserving
inner city setting results in happy participation by all involved. Baseline and long-term data
collection is needed to determine an objective outcome in terms of sustainable effects on activity,
health, and prevention of obesity.

Title: A Collaboration to Provide Back-to-School Vaccines.

Authors: A Gehle (PGY-2), G DeAngelis (PGY-2), S Jeng (PGY-3), C Nosek (PGY-2), A
Turner (PGY-2), AK Kuo (Assistant Clinical Professor).

Department of Pediatrics, University of California at San Francisco (UCSF)

In August 2005, five pediatric residents completed a one-month community project. We
partnered with the San Francisco Unified School District (SFUSD) to assist in developing their
back-to-school vaccine program.

Target Audience:
School-age children entering the SFUSD who are under-immunized, immigrants, or new to the

To work with multiple community organizations to 1) ensure timely school entry for under-
immunized children and 2) increase access to local public health insurance programs.

1) Planning meetings with the Department of Public Health, the SFUSD, the UCSF Children’s
Hospital administrators, and the City of San Francisco Mayor’s office. 2) Coordination of 5
half-day clinics at the SFUSD, where we reviewed immunization records in multiple languages
and administered vaccines and tuberculin tests. 3) Collaborating with a major local public health
insurance provider to offer enrollment information.

We administered >190 vaccines and >100 tuberculin tests for 110 children ages 5-17 years from
>15 countries who were therefore able to begin school on time. Access to public health
insurance programs was offered by an eligibility expert at each clinic.

Lessons Learned:
We learned about: 1) collaborating with multiple community groups to avoid duplication of
efforts and resources, 2) establishing a medical intervention in a non-medical setting, 3) the
barriers to timely school enrollment, 4) the importance of considering the medical home, 5) how
to address an important child health issue in a limited time frame through community
partnerships. We advocate for the implementation of countywide physician access to vaccine

Title: Military community needs assessment of orphans and vulnerable children (OVC) in South

Authors: Katrina Gray(PGY3), Linnea Axman

Naval Medical Center San Diego

There is an estimated 23% HIV prevalence rate among SA military and an estimated 1.1 million
children orphaned by HIV in SA. The basic needs of OVC may not be met because communities
are poorly equipped to absorb the large number of orphans.

To assist the South African Military Health Service (SAMHS) in a community needs assessment
of military OVC affected by HIV/AIDS.

A community-based participatory process guided the formation of local action groups in four
provinces. Information was gathered regarding local demographics, cultural beliefs/practices,
health statistics, and community assets. The identification of priorities and development of
interventions were guided by data analysis, leadership, and community participation.

Province A and B found cultural beliefs and the subordinate role of women to influence the
rising number of OVC and the success of HIV programs. In Province C, HIV stigma and misuse
of foster grants lead to OVC mistreatment/exploitation. In Province D, OVC may not be
provided with basic needs. Lack of education, poor male attendance at community outreach
efforts, and the large number of children without legally identifiable fathers may contribute to
the vulnerability of OVC. Across provinces, the underreporting of OVC was identified.

Participatory methodology is an effective technique to prioritize health problems and
interventions. Establishment of a system to identify military OVC will enable interventions
aimed at the identified health-related problems.

Title: Homeless children and Medicaid HMOs

Authors: Cori Green, MD, Beth Volin, MD, Molly Martin, MD, Priti Jani, MS, Margaret
Scotellaro, MD

Rush University Medical Center

Homeless families face many barriers to obtaining adequate healthcare for their children. We
performed this study to determine if type of Medicaid insurance, specifically traditional
Medicaid vs. Medicaid HMO, influenced homeless children’s access to healthcare.

We surveyed 156 caregivers about their children’s healthcare experiences (n=347) at 11
homeless shelters in Chicago during 2005. Analyses were performed using chi-squared tests.

Thirty-five percent of children were on Traditional Medicaid, 58% were on a Medicaid HMO,
3% were enrolled in private insurance, and 12 % had no insurance. Most caregivers (93%) said
they would choose Traditional Medicaid for their children if given the choice today. 93% of
caregivers with children on Traditional Medicaid would chose to stay on Medicaid, while 72% of
caregivers with children on Medicaid HMOs would prefer to be on Traditional Medicaid
(p<0.01). Most caregivers, regardless of insurance, could identify a primary physician for their
child. However, 77% of parents with children on Traditional Medicaid stated their child could
see their doctor today if ill, compared to only 60% of parents with children on Medicaid HMOs

Homeless caregivers in our study stated their children have better access to healthcare when
insured by Traditional Medicaid than Medicaid HMOs, and would prefer to be on Traditional
Medicaid. This suggests that access to appropriate medical care for homeless children is at risk
as federal policies decrease Medicaid funding and more children are placed on HMOs.

Title: Advocacy for the Poor: an elective pediatric residency rotation

Authors: Marsha R. Griffin, MD (3rd year resident in pediatrics), Javier Kane, MD (Associate
Professor of Pediatrics), Joseph B. McCormick, MD (Regional Dean and James Steele Professor)

University of Texas School of Public Health-Brownsville Regional Campus

Poverty continues to be a major component of children’s ill-health. Pediatricians are often
incapable of addressing the complicated social milieu which perpetuates poverty and disease.
The UTHSCSA, in collaboration with the UT School of Public Health and local advocacy
organizations, proposes to develop a one-month elective rotation in advocacy for the poor along
the Texas-Mexico border.

The program will offer fifty elective rotations to pediatric residents (PGY2 and PGY3) from U.S.
programs over a five-year period.

   1) To learn the social determinants (Content) of childhood health and disease in resource-
      poor regions.
   2) To become aware (Attitude) of the impact of poverty on health.
   3) To become active advocates (Skills) for change.

   1) Review a comprehensive curriculum examining the social determinants of disease.
   2) Survey advocacy projects in the region.
   3) Provide home visits on both sides of the Border and view documentary films highlighting
       the history and roots of poverty.
   4) Prepare a lecture on an advocacy issue for presentation at their home institution.

Outcome evaluation:
  1) Complete pre and post tests after each of the didactic five-module curriculum.
  2) Compose a reflective essay describing the effects of poverty on the children they served.
  3) Complete an interview and questionnaire at the end and three months after completing
     the elective.

Lessons to be learned:
   1) Develop greater insight into social determinants of pediatric illness and health.
   2) Personalize the face of poverty in clinical practice.
   3) Become empowered as active agents for social change.

Title: Reach Out and Read: A Resident-Driven State-Wide Expansion

Authors: Emily A. Hannon, PL-2, Stacey Townsend, PL-2, Angelika Valdez, PL-1, Wendy
Hobson, MD, Faculty Mentor

University of Utah Pediatric Residency Program

Timeline: July 2005-June 2006

Target Audience: Utah children ages 6 months to 5 years.

Goals / Objectives: Reach Out and Read (ROR) is a well-established national program with
proven benefits. Despite ROR’s international presence, there are only 9 ROR sites in Utah,
reaching less than 5% of Utah’s low-income children. In our first collaborative resident-based
advocacy project, the pediatric residents at the University of Utah aim to expand ROR in Utah.
Our objectives are to increase the number of ROR sites, children served and books distributed in

Activities: Potential family medicine and pediatric practices were identified and a letter sent
explaining ROR and its benefits. Residents solicited interest from practitioners by writing
articles in local pediatric society newsletters, speaking at resident lectures and presenting at
Grand Rounds. Residents are available to support interested practices by providing application,
fundraising, and volunteer recruitment assistance. By collaborating with Utahealthnet, a
statewide consortium of libraries, we will reach children throughout Utah. Collaborations with
high schools and universities will provide a cadre of volunteers available to ROR practices.

Outcome Measures: Success of the state-wide expansion will be measured by the number of
books distributed, children served and comparison of sites actively participating in ROR pre- and
post-intervention. Our goal is to enroll at least one pediatric or family medicine practice in each
of Utah’s 29 counties.

Lessons learned: Residency-wide projects are challenging, and most work is preformed by the
most enthusiastic residents. Reaching out to practices provides an important link between an
academic institution and private practices.

Title: Curbing Obesity in Partnership with School-Based Health Centers: The Cincinnati
Children’s Experience

Authors: Melissa Keene, MD PGY-1, Ryan M. Buchholz, MD PGY-2, Stephen E. Wilson, MD,
Caroline V. Mueller, MD

University of Cincinnati Internal Medicine and Pediatrics Residency Program

Childhood obesity is increasing at an epidemic rate. Estimates from the Centers for Disease
Control indicate that 16% of children ages 6 – 11 are overweight (body mass index ≥ 95% for
age). Childhood obesity is not equally distributed among the population as the prevalence
among African Americans is significantly higher than Non-Hispanic Whites (20% vs. 14%).
Given the health consequences associated with obesity, educational programs improving
children’s health behaviors are critical.

To reduce obesity in 4 urban elementary schools through collaborations with school-based health

Target Population:
Families whose children attend urban elementary schools in Cincinnati, Ohio

Specific Aims:
To implement a culturally sensitive health promotion curriculum that:
   1. Raises awareness of the long-term health effects of childhood obesity
   2. Promotes healthy nutritional choices
   3. Increases physical activity

Outcome Measures:
 1. Increased knowledge of healthy lifestyle choices, measured by a questionnaire
 2. Improved health status, measured by the Pediatric Quality of Life Inventory, a well-
    validated health status instrument for children

Project initiation and planning will be completed by Fall 2006. Implementation will then begin at
the first school. Four elementary schools have Cincinnati Children’s Hospital sponsored school-
based health centers, staffed by pediatricians and nurse practitioners. The program will expand
to all schools by Fall 2009.

Lessons Learned:
Early collaboration and coordination with school leaders, physicians, and community advocates
is crucial to effectively implement a plan to curb obesity among schoolchildren.

Title: Reducing Health Disparities: Residents partnering with Schools and the community to
optimize asthma care

Authors: Kate Leonard (PGY3), María Cecilia Mosquera (PGY2), Lisa Chamberlain, Laurie
Bauer, Janine Bishop.

Stanford University School of Medicine, Division of General Pediatrics
Ravenswood City School District (RCSD), East Palo Alto, California


Target Audience:
Children and families with asthma in the RCSD where asthma rates are triple those of
neighboring districts. This underserved community is home to impoverished families (85%
school lunch assistance) with language-barriers (70% primarily Spanish-speaking).

Goals and Objectives:
Development of a comprehensive, community-based program to reduce asthma in these children.

This project was a collaborative, community-driven partnership between the school district,
residents, local pediatric providers, and community-based organizations. Per request by local
providers we created an asthma card with NHLBI guidelines and covered asthma medications,
and distributed an “Asthma Action Plan” to improve asthma care. We streamlined the district’s
medication authorization form, which activates school-based prevention programs including
bilingual asthma classes for families and teachers and a home visitation program to reduce
asthma triggers. Through a grant we instituted an Asthma Case Manager.

Outcome Measures:
Process outcomes included identification of 495 asthmatic children, completion of 142
medication authorization forms and 87 Asthma Action Plans, education of 126 parents and 21
students through asthma classes, completion of 12 home visits, and hiring one Asthma Manager.
Other anticipated outcomes under investigation include: 1) school absenteeism and ER
visit/hospitalization rates over the 3 years before and after intervention, 2) the ratio of controller
versus rescue medication prescriptions as a proxy for improved quality of care.

Lessons Learned:
Ensuring sustainability is a challenging but crucial part of any advocacy project. Community-
driven programs that address the community’s priorities are more likely to sustain change.
Resident education is advanced through advocacy work.

Obtained through the Packard Children’s Hospital Innovations in Patient Care Grant.

Title: Resident physicians’ knowledge and attitudes about health disparities

Authors: Manchanda R, Mahajan AP, Fernandez H, Kuo A, Shapiro MF.

UCLA Department of Medicine & Department of Pediatrics.

APA Educational Guidelines emphasize the need for residency to incorporate training in
reducing health disparities. Little is known about residents’ knowledge and attitudes regarding
the societal and health system factors that contribute to health disparities, nor their willingness to
develop advocacy skills to improve access.

Determine residents’ 1) knowledge and attitudes regarding health disparities, and 2) perceptions
of their preparedness, training, and willingness to address factors that perpetuate disparities.

From 12/2005 through 4/2006, a confidential survey will be offered to all Pediatric, Internal
Medicine, and Family Medicine residents in L.A. County.

To date, 76 residents have participated. Understanding health disparities is ‘important’ to ‘very
important’ for residents pursuing primary care (98%) or subspecialty careers (84%). However,
many felt only ‘somewhat’ or ‘not prepared’ to care for patients who have limited English
proficiency (59%), are uninsured (58%), or have income below the poverty line (53%). 85% felt
that understanding the eligibility requirements of public health insurance programs is important,
but only 18% reported receiving any training. 90% are willing to replace one clinical noon
conference per month with one on health disparities. 36% are willing to accept at least a $20,000
reduction in future annual salary to absorb the cost of caring for underserved patients.

Conclusion: Residents’ willingness to participate in health disparities training and to contribute
future earnings towards caring for underserved patients reflects a previously undocumented
commitment to these topics. Curricular innovations to train physicians to reduce health
disparities and develop advocacy skills are required.

Title: Are We Training Advocates? Perceptions and Experiences of Patient Advocacy from
Fourth Year Medical Students

Authors: Maireade McSweeney, MD, MPH1, Wayne LaMorte, MD, MPH, PhD2, Megan
Sandel, MD, MPH3 and Lauren Smith, MD, MPH3. 1PGY-1

Boston Combined Residency Program, Children's Hospital
Boston/Boston Medical Center, Boston Department of Epidemiology
Boston University School of Public Health Department of Pediatrics
Boston Medical Center, Boston

Patient advocacy is becoming a nationally recognized part of medical education. There is an
increasing trend to enhance medical students exposure to advocacy in their physician training

The goals of this study were: (1) to investigate medical students opinions of patient advocacy in
their medical education and future careers; (2) to examine students’ exposures to patient
advocacy through their third year clerkships.

An anonymous, self-administered survey was given to graduating fourth year medical students
from Boston University School of Medicine s Class of 2004. The survey consisted of multiple-
choice questions and an open-ended question, as well as Likert-type questions, ranging from
1=strongly agree to 5=strongly disagree and included a 0= Do not know.

115 of 139 graduates (82.7%) completed and returned the survey. 86% students had heard of the
term patient advocacy prior to the survey; 91.9% agreed/strongly agreed that patient advocacy is
an important area of clinical medicine.

Students’ perceptions of patient advocacy differed significantly depending on gender and future
career plans. A multiple linear regression analysis found that gender differences were more
significant than future career plans as predictors for differences in students perceptions of
advocacy; women attached more importance to patient advocacy in medical education (p=.009),
felt that more time should be devoted to advocacy in the curriculum (p=.004), and attached more
weight to its future importance in their careers (p=.003).

Students also reported significant differences in the extent to which patient advocacy was
emphasized by third year clerkships: students rated family medicine (72%) and pediatric (69%)
clerkships as the most encouraging/strongly encouraging physician-patient advocacy discussions.

Conclusions: Most students were aware of the concept of patient advocacy and thought it was an
important part of their medical education. Clinical curriculums may benefit from improving
students advocacy exposure across all clerkships/medical disciplines and better targeting of
gender advocacy perception differences.

Title: A Prospective Study of Deaf Community Assess to Health Care

Authors: Wendy Osterling, MD-PL-2, Karen Buchi, MD and Wendy Hobson, MD

July 2005-2006

Target Audience:
Deaf and Hard of Hearing (DHH) individuals in the Salt Lake City area

Deaf and Hard of Hearing (DHH) individuals have a wide range of communication styles,
hearing loss severity, and education levels. Health fairs, education classes, and educational
advertisements are often in the form of videotape, verbal presentations, and other methods,
which are inaccessible to DHH individuals.

Our goal is to create an exchange of educational materials and information that is accessible to
the hearing impaired community. Our objective is to meet a need in the DHH community and to
better understand their communication styles and needs.

Doctors, nurses and community advocates have identified a need to better inform and educate the
deaf communities of the Greater Salt Lake City area. Dr. Osterling gives monthly health
education lectures at the Deaf Center. A health fair with sign language interpreters, assistive
listening devices and visual materials will convey information in a format conducive to people
with hearing loss. Collaborations with local health organizations will allow these organizations
to reach the hearing impaired community. DHH participants will complete a survey asking
questions about preferred communication style, source of health information, what additional
information is needed and how they wish to receive it.

Outcome Measures:
Project success will be measured by number of people served in lectures and at the health fair
and their responses on a satisfaction survey. Survey results will be analyzed for common
themes, which can be used for programmatic planning.

Lessons Learned:
Collaboration is essential to programmatic success.

Title: Diaper Duty

Authors: John Mytinger, M.D. (PL-1), Diane E. Pappas, M.D., J.D.

University of Virginia Children’s Hospital, Charlottesville, VA

Target Audience:
Medically indigent families who receive care in our Primary Care Clinic. Qualifying families
must be uninsured, have one working parent, and have an infant less than 12 months old.

Goals and Objectives:
To develop an advocacy program that distributes diapers, wipes, and rectal thermometers to
children of indigent families.

 The intern class convened monthly and assigned tasks to each intern. Interns were given
dedicated time and leadership rotated monthly. Tasks included identification of a target
population, investigation of a partnership with a national organization, preparation of a funding
request, and drafting of proposals. Funding sources were identified and start-up costs were
successfully obtained from a community contributor. Future activities include solicitation of
additional community partners, negotiation with potential corporate sponsors, and program

Outcome Measures:
 Objective measures include the number of families enrolled and products distributed.
Subjective measures include the quality of the intern experience as well as the knowledge gained
about community advocacy and the needs of our patients.

Lessons Learned in Implementation:
We learned how to formulate a project, identify a target population, and write a funding request.
We overcame several barriers, including failure to partner with an established national program
due to indemnity issues; this experience led us to establish our own independent diaper program.
We gained a better understanding patient needs. Financing and future resident and faculty
support will be integral for sustaining the program.

Title: Improving Health Literacy with a DVD of Anticipatory Guidance Tips

Authors: Heather Paradis, M.D. (R3); Neil Herendeen, M.D.; C.Andrew Aligne, M.D., MPH

Pediatricians are called upon to guide parents through a myriad of questions and dilemmas about
their growing children. Due to time constraints, many rely on handouts to communicate
important safety and developmental information. However, considerable evidence indicates that
parents often have difficulty comprehending written handouts. Is there a more captivating and
user-friendly way to deliver important information so that it is retained, used, and disseminated
to others?

To provide more effective health education and improve health literacy in the primary care
setting using a DVD of 9-month old anticipatory guidance tips distributed at well-child visits.

The DVD was developed with community partner Rochester Parent Network. Topics covered:
Development, Dental, Safety, Car seat, and Nutrition. We created a script for each core segment
and recruited qualified professionals to be on-camera experts. Each segment starred 9-12 month-
old babies.
We plan to have some parents receive written format and some receive the DVD of anticipatory
guidance, to be distributed at the 9-month well-child visit. Will follow-up with families at the 1-
year visit and survey how they used the information provided. Will also administer a “post-test”
to see if material retained was different between the two cohorts of parents.

All segments are taped and are currently being edited for distribution at 9-month well-child
visits. We showed an early version of the DVD to a pilot group of parents and received positive

A DVD of anticipatory guidance tips presented as vignettes with live babies shows promise as an
effective way to deliver information to parents.

Title: “You smoke you will choke”: Evaluating a 4th-5th grade school-based smoking prevention

Authors: Sarah Pitts MD (PGY2)1, Dmitry Dukhovny MD (PGY2)1, Lisa Roy MD (PGY3)1,
Emily Willner (PGY3)1, Justin Linam BA, MM2, Wanessa Risko MD3, Romi A.Webster MD,
  Boston Combined Residency Program (BCRP), Children’s Hospital Boston and Boston Medical
Center, Boston MA
  Harvard University, Cambridge, MA
  Children’s Hospital Primary Care Center, Children’s Hospital Boston

Cigarette smoking causes an estimated 440,000 deaths each year in the U.S. Smoking initiation
occurs as early as ages 11-12. ACT (Advocacy Clinic Training) is a resident-run program
introducing pediatric residents to advocacy. As part of this program, residents created a smoking
prevention curriculum geared towards 4th-5th graders.

To obtain student feedback on a pilot school-based smoking prevention curriculum.

Pediatric residents facilitated a 30-40 minute long interactive session with students, eliciting their
views about tobacco use and its effects. Residents discussed the short and long term effects of
smoking. Seventeen students completed anonymous pre-session surveys (3 questions), and 39
students completed anonymous post-session surveys (6 questions). Basic descriptive analysis
was performed in aggregate.

Results: The proportion of children who had no response to the question how smoking once
could affect the body, decreased from 41% (7/17) to 5% (2/39) post-curriculum. Also, 92%
(36/39) of students could specify a long-term effect of smoking after the curriculum as compared
to 65% (11/17) prior. The majority of the students reported learning something from the
residents (77%, 30/39). However, post-curriculum, 28% (11/39) had unanswered questions about
tobacco/smoking, and 23% (9/39) had questions about drugs and alcohol.

This smoking prevention curriculum teaches 4th-5th graders valuable lessons about smoking at an
important age. Further research is needed to evaluate whether or not the lessons learned persist
beyond the teaching session. The prevalence of residual questions indicates a need for review of
content and adequate time to address these important topics.

Title: Barriers Towards Breastfeeding Among African American Women: A Community
Analysis for Intervention

Authors: Gisela Porras, MD (PGY3), Colleen Kalynych, MSH, Matthew Benson, MD (PGY2),
Liberty Dizon (PGY3), MD, Edessa Jobli, MPH, Ru-Jeng Teng, MD

University of Florida Jacksonville

One goal of HP2010: increase breastfeeding rates to 75%. Although national breastfeeding rates
are increasing (White 71%; Black 50.8%), rates at our hospital are substantially lower (51% all

1) Determine perceived barriers towards breastfeeding among AAW who delivered at our
hospital, and men and women in the community; and 2) Develop a community-wide intervention
(through breastfeeding coalition) to increase breastfeeding rates in our area.

AAW (n=30) who delivered at our hospital were interviewed and AA community members
(n=31) participated in focus groups to determine beliefs about breastfeeding; reasons why fewer
AAW breastfeed in our area; and ideas to increase breastfeeding rates.

Women who delivered (40%; WDH) and focus group participants (42%; FGP) pointed to the
perception that breastfeeding is inconvenient as why fewer AAW breastfeed. Positive messages
about breastfeeding, specifically convenience (p <.05) and baby’s development (p<.05) were
significantly associated with why study participants chose to breastfeed. Pain was the
predominant negative message about breastfeeding (60%). Providing education (47%; WDH;
39%; FGP); specifically demonstrating how to breastfeed and the manageability of breastfeeding
were ideas of how to increase rates (30%; WDH; 22%; FGP).

Conclusion/Actions for Coalition:
Participants could clearly discuss benefits of breastfeeding however; few felt that breastfeeding
was convenient or manageable in their lives. Many were afraid of breastfeeding because of
perceived pain, or stopped because of pain. The ability to educate; specifically regarding
convenience, manageability, and proper positioning through support, may significantly increase
the number of AAW who chose and succeed at breastfeeding.

Title: Expanding the Safety Net: Public Insurance for Adolescents after their 18th Birthday

Authors: Joshua P Rising, MD, MPH1, Ellen Kaiser, RN, MHA3, Elena Fuentes-Afflick, MD,
MPH1 and Mitch Katz, MD2.
  Department of Pediatrics, University of California, San Francisco
  Department of Public Health, SF, CA
  San Francisco Health Plan, SF, CA

18-25 year-olds have the lowest rate of insurance of any age group in the United States. This is a
serious gap, as this age group suffers from a high disease burden in areas such as asthma and
mental health and is of childbearing age. To address this problem, San Francisco County started
a unique program, Healthy Young Adults, in 2004 to provide insurance to some low-income
youth aging out of publicly funded insurance for children.

- Describe the program inception
- Provide details of the program and its operation
- Examine characteristics of patients who enrolled in the program
- Describe current healthcare utilization patterns and costs incurred by program participants

A database from San Francisco Health Plan, the managed care organization responsible for
administering Healthy Young Adults, was queried to obtain data on two questions:
1. How do the characteristics of individuals who chose to enroll in the plan differ from those who
did not?
2. What were the healthcare utilization and associated costs of those who enrolled in Healthy
Young Adults?

Approximately 20% of those eligible to enroll in Healthy Young Adults did so. 75% of the
young adults enrolled themselves, while 25% were enrolled by a parent or other individual. Men
and women were equally likely to enroll. Among eligible individuals, 33% of Asians and 20% of
Hispanics enrolled; less than 10% of Caucasians and African-Americans did so. Those who had
used pharmacy services in the years prior to enrollment were more likely to enroll in Healthy
Young Adults. Data analysis on current healthcare utilization and costs of individuals in Healthy
Young Adults is ongoing.

Conclusions: San Francisco County has successfully implemented an innovative program to
help adolescents transition to adulthood while maintaining access to healthcare. Youth with
greater needs (based on pharmacy utilization) were more likely to enroll in the program. More
work is needed to understand why Asians and Latinos were more likely to enroll. Data analysis
to document utilization patterns and costs is ongoing. Although this evaluation remains at the
formative stage, initial results suggest that this may be a replicable program for other

Title: ACTing Together: Resident Advocacy in a Primary Care Clinic

Authors: Lisa P. Roy MD (PGY3),1 Lisa Swartz MD (PGY3),1 Justin Linam MM,2 Emily J.
Roth MD,3 Romi A. Webster MD, MPH4
  Boston Combined Residency Program, Children’s Hospital Boston and Boston Medical Center,
Boston, MA
  Harvard University, Cambridge, MA
  University of California at San Francisco, Division of General Pediatrics
  Children’s Hospital Primary Care Center, Children’s Hospital Boston


Target Audiences:
Pediatric residents, community agencies, schools, and families

Goals and Objectives:
In 1999, ACT (Advocacy Clinic Training) was created by residents and faculty at the Children’s
Hospital Primary Care Center (CHPCC) to enhance resident training in child advocacy. During
the past two years, resident interests focused the program’s efforts into three main areas:
Children with Special Health Care Needs (CSHCN), Substance Abuse Prevention, and
Breastfeeding Promotion. While serving community needs, residents learn about the importance
of advocacy and the impact they can make at individual, community, and state legislative levels.

Residents at CHPCC have one clinic afternoon each year devoted to an advocacy experience of
their choice. For example, the Substance Abuse group taught a smoking prevention curriculum
to local elementary students. The Breastfeeding Promotion group worked with lactation
consultants at hospitals and within community organizations to identify and address local
barriers to breastfeeding. Residents conducted home visits for families with CSHCN, gaining
insight into their daily lives and barriers to access. Residents also met with state legislators to
advocate for related policy changes.

Lessons Learned:
Advocacy is a fundamental aspect of pediatric training. The greatest challenge has been
maintaining momentum within the limited time allowed by busy resident schedules. However,
the ACT program creates an organized infrastructure for residents to learn from personal and
peer advocacy experiences. In addition, ACT and CHPCC faculty support residents interested in
implementing ongoing advocacy projects. Feedback has demonstrated ACT’s ability to
continually evolve to meet resident and community needs.

Title: Mobile Medical Home for Children in Foster Care

Authors: Monica Stoffer, MD (PGY3), Alice Kuo MD, PhD

Mattel Children’s Hospital at UCLA

Brief Project Summary:
Caring for children in foster care provides unique challenges, such as not having medical records
or losing documentation of life events (i.e. photographs). With an AAP resident CATCH grant,
this project was designed to create a “Mobile Medical Home” notebook for children in foster

Target Population:
This project targeted children in foster care either cared for in UCLA resident continuity clinics
or placed through the Westside Children’s Center, a family resource center and foster care

Goals and Objectives:
Our overall goal was to improve continuity of health care for children in foster care. To achieve
this, we had the following objectives: 1) to ask foster parents about the need for documentation
of medical and life events, 2) to create a documentation system, 3) to connect with each foster
child’s pediatrician, and 4) to improve resident education about caring for children in foster care.

We accomplished our objectives by the following activities: 1) a series of key informant
interviews with experienced foster mothers, 2) a meeting with the Medical Director of the
Department of Child and Family Services for Los Angeles County, and 3) a “Make and Take”
event with foster mothers and pediatric residents.

Lessons Learned in Implementation:
Foster mothers shared that any information about the child’s past is useful, even if it is just one
picture or an immunization record. Pediatricians should speak with foster parents separately
from children to discuss sensitive psychosocial issues. Finally, we found that it was important to
connect families with resources to address issues that came up while reviewing the medical

Title: “Creating a Mentoring and Advocacy Project for Incarcerated Native American Youth in a
State Juvenile Justice Facility”

Authors: Yolandra Gomez Toya, MD, MPH (Resident Year 2), Department of Pediatrics; Tassy
Parker, PhD, RN; Gayle Dine Chacon, MD, Department of Family Medicine, University of New
Mexico Health Sciences Center.

Background: This project was a resident initiated advocacy project designed to collect
information about Native youth incarcerated in a New Mexico (NM) state-run facility. The data
collected helped create a foundation for a mentoring and advocacy program for these youth in
need of mental and behavioral health services.

Methods: This was a systematic chart review-descriptive analysis of medical and social
information of incarcerated Native youth (N=80) at a state-run facility in a one-year time period.

Results: Native females were twice as likely as other females to be incarcerated. Two-thirds
came from one county in northwestern NM, and one-quarter were sentenced by one judge. All
clients reported having used alcohol or drugs by an average age of 11 and 13 years.
Approximately 82% had a diagnosable Axis I disorder, and of these, 73% had 3 or more
diagnosable disorders. Almost 94% of the females and 8% of the males reported some type of
sexual abuse history. 53% of females and 67% of males reported alcoholism in the family.

Conclusion: This pilot project collected medical and social information on this little known
population. Further investigation is warranted into the over-representation of Native females and
relationships between incarceration and substance abuse, mental health and trauma history. In
addition, we discuss how this information is used to support a mentoring and advocacy program
for incarcerated Native youth, in particular the development of a multidisciplinary coalition
made up of representatives from tribes, juvenile justice facilities, mental health providers,
families of incarcerated youth, and community members.

Title: The Period of Purple Crying: A Resident Advocacy Project to Reduce the Incidence of
Shaken Baby Syndrome

Authors: Hillary Tuttle, MD (PGY-3) and Cynthia L. Ferrell, MD, MSEd

Oregon Health & Science University

Child advocacy and child abuse training are important parts of pediatric residency training. An
advocacy curriculum at Oregon Health & Science University (OHSU) has been created and
includes an advocacy lecture series coupled with longitudinal resident team projects. The OHSU
Period of Purple Crying Program is a result of this curricular intervention.

To use the advocacy curriculum to create a resident directed project that implements the Period
of Purple Crying Program into clinical care.

The Period of Purple Crying Program (PPC) is the result of a 2-year advocacy project developed
in an attempt to model the success of a similar program in New York and reduce the incidence of
Shaken Baby Syndrome (SBS) in our community. The PPC program is an educational program
for new parents directed at informing them about the normal patterns of crying and the risks of
SBS. On a monthly basis, as part of the advocacy curriculum, our advocacy team of 6 pediatric
residents and 1 faculty mentor were given time apart from clinical duties to develop and
implementation an advocacy project.

The Period of Purple Crying program has been unanimously accepted by all providers of
maternal/newborn care at our institution. We are currently in the stage of educating nurses, social
workers, and physicians about SBS and the PPC program.

This project shows an advocacy program that couples education with pediatric resident and
faculty teamwork can result in projects that may directly affect our community and the welfare
of our patients.

Title: Interdisciplinary Advocacy: Community Leadership and Resident Education in Oral

Authors: Michele N. Lossius, MD, Kristen M. Eisenman, MD and Maureen Novak, MD.

Pediatrics, University of Florida

In the spring of 2005, the primary care lecture series included a lecture from the UF Pediatric
Division of the College of Dentistry. The lecture highlighted the current state of oral health in
children, access concerns, and the Surgeon General's "Call to Action". At that time two residents
were embarking on required continuity clinic quality improvement projects, completing
advocacy rotations, and the CATCH cycle was starting.

Apply skills obtained in various domains to improving child health care
To learn the grant process
Complete and apply QI projects in clinic
Form lasting interdisciplinary partnerships to ensure continuing support and outreach

Dental caries are the most prevalent infectious and chronic disease in children. Poor and minority
children suffer twice as much dental caries due to lack of access. Knowing that topical fluoride
reduces dental caries 20%−40%, and that the costs of treating early childhood caries are
profound, the project sought to:
1) Educate pediatric residents about oral health pathology, dental screening, and fluoride varnish
2) Provide biannual oral exams by pediatric residents to a target population
3) Apply topical fluoride varnish biannually to children ages 1 to 2 years
4) establish local community partnerships
5) Petition Florida legislature for future funding of the implementation of the project locally and

All pediatric residents completed an online course for oral health education and fluoride varnish
Two residents were able to incorporate knowledge of community needs and evidence based
medicine into a grant proposal.
Applied for a CATCH grant
Formed partnerships with the UF College of Dentistry and an undergraduate student
Began the project

Residents are successfully incorporating oral health education and fluoride varnish application
into well child checkups at three continuity clinic sites. In addition, interdisciplinary partners
have been established and residents are pursuing additional avenues for project sustainability.

Title: Counseling the Breastfeeding Teen Mother: What Challenges Do Providers Face?

Authors: Carolyn Y. Jacobs Parks, MD,MPH1 and Nancy Chin, PhD1. (Sponsored by David
Siegel) (Eastern SPR Sponsored by David Siegel)

Pediatrics, University of Rochester, Rochester, NY.

Breastfeeding provides the best source of nutrition for an infant. The rates of breastfeeding in the
US are low compared to other developed nations and the goals outlined in Healthy People 2010
are not being met. Although most women are not meeting the goals, the rates of breastfeeding
amongst adolescent mothers are much less than those of older women.

Identify how providers counsel adolescent mothers on breastfeeding and identify the barriers
they may face in performing the counseling.

A self−report mailed survey was sent to 650 primary care providers, (pediatricians, family
physicians, obstetrician/gynecologists, pediatric and family nurse practitioners, and certified
nurse midwives) WIC (Women, Infants & Children) nutritionists and lactation consultants in
Monroe County, NY during the months of February through April, 2005. A single open-ended
question was coded for themes under the domains of factors intrinsic to the teen (and thus
requiring in office counseling strategies) or extrinsic to the teen (requiring advocacy for system's
changes). The survey response rate was 58%. Descriptive statistics and Chi-square analyses
between groups were performed using SPSS statistical analysis software.

Greater than 50% of all providers surveyed felt very prepared to counsel adolescent mothers on
breastfeeding. Providers who felt it important to counsel a pregnant adolescent mother about
breastfeeding during a routine visit did so most often during prenatal visits (X2=11.5, df=2,
p<0.003). Barriers encountered during counseling were both intrinsic and extrinsic to the
adolescent mother. Examples of a) intrinsic and b) extrinsic factors which emerged from the data
include: a) knowledge deficit, lack of commitment, immaturity, and b) lack of family
support/encouragement, time constraints, and inadequate supply of high quality breast pumps.

More work still needs to be done to improve the rates of breastfeeding in this population.
Providing ongoing continuing medical education for providers and adolescents is a key initial

Title: Metal Health in Elementary Schools

Authors: Dzung Vo MD (R2), Betty Chapin MD (R2), Donna Goff MD (R3), Tina Hermos MD
(R3), Liana McCabe MD (R3), Anda Kuo MD (Faculty Mentor)

University of California, San Francisco, Department of Pediatrics

Elementary school students in San Francisco have significant mental health needs.

Survey San Francisco Unified School District (SFUSD) elementary school nurses (ESN) and
Learning Support Consultants (LSC) regarding their students’ mental health needs available
mental health resources. Advocate for improvement in mental health services and
interdisciplinary communication.

Anonymous surveys included quantitative and qualitative items. Findings were discussed with
relevant officials in the San Francisco Department of Public Health.

Nine nurses (56% response rate) and 2 LSC’s (15% response rate) returned surveys. When
asked what percentage of their students have mental health needs, the average response was
47%. Regarding children with mental health needs, 57% felt these needs “not being met.”
Forty-five percent of respondents felt that “almost all” students were impacted by potentially
traumatic experiences. Regarding mental health needs affecting students’ ability to learn, 55%
felt the students were “extremely” impacted.

Many respondents mentioned dysfunctional family problems and violence in children’s’ lives.
Concerns were raised regarding perceived lack of resources and insufficient continuity and
follow-up. Finally, many respondents reported insufficient communication and coordination
among the various providers and agencies.

ESN’s and LSC’s perceive that a high percentage of their students have mental health needs.
They perceive that these mental health needs are not being adequately addressed, and that these
needs have a significant impact on students’ ability to learn. We hope that by sharing our
information we can enhance interagency communication around children’s mental health and
ultimately improve the mental health services for children.

Title: Downsizing Childhood Obesity

Author: Beau C. Weill, M.D.Resident PGY-3

Oregon Health & Science University

Program Description:
In 2004, in conjunction with our child advocacy curriculum, Project REACH, we created a
Childhood Obesity Special Interest Group (COSIG). This COSIG consists of a team leader, a
faculty advisor, medical students, and pediatric residents who are interested in advocacy projects
relating to childhood obesity. Our timeline varies for each project, however, we recruit new
members each year, allowing for an infinite course of advocacy.

Goals and Objectives:
To work with our immediate community in order to combat the rise of childhood obesity.

Our list of activities includes: analyzing data on BMI’s from our general pediatric clinics;
creating health education classes at a local charter middle school; legislative work on re-
incorporating physical education into our schools; formatting information into a booklet-style
handout for overweight and obese patients; working on education regarding the media’s
influence on food selection; and working to create a wellness policy for the Portland Public
School District .

Outcome measures:
Because most of our projects are in planning stages, we do not have immediate assessments of
outcome measures. However, our obesity patient handbook will have a survey to evaluate its
effectiveness, as well as an opportunity for families to give direction for the discussion of issues
related to overweight and obesity.

Lessons Learned:
Lessons learned from this COSIG include: 1) ways to overcome specific barriers encountered in
the pursuit of our goals; 2) more effective means to discuss overweight and obesity amongst our
patient population and in the classroom setting; and 3) characteristics of our local overweight and
obese population.

Title: Child Passenger Safety (CPS): A Resident’s Responsibility.

Authors: Kristi Williams, MD PGY 2 and M. Denise Dowd, MD, MPH

Motor vehicle crashes are the number one cause of death in children. Because residents provide
guidance to parents about child safety issues, knowing current CPS recommendations and
educating parents about correct CPS usage could help prevent deaths and injuries to children
involved in motor vehicle crashes.

To develop and deliver a tailored child passenger safety training module taught by a pediatric
resident for pediatric residents.

In May 2006 a survey was completed by PGY 1-4 pediatric residents testing residents’
knowledge of current CPS recommendations and state CPS law. Based on the results of this
assessment a training module was developed that gave feedback on the residents’ knowledge,
current CPS recommendations, and gaps in state law. Training consisted of a didactic session
given during orientation for new residents and continuity clinic teaching time, including a hands-
on demonstration and practice session. A follow up knowledge survey is planned for April, 2006.

A total of 42 residents (55%) returned the initial survey. Major gaps in knowledge included
actual versus predicted CPS usage, transition to and usage of booster seats, injuries sustained
with incorrect CPS usage, and common errors in CPS installation. The training module was
given by a trained CPST resident (KW) five times for a total of 67% residents trained. A one-
year post-training assessment will be presented.

It is feasible to develop and deliver a customized CPS brief training session to pediatric residents
within allotted didactic sessions.


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