Showing posts with label community pediatrics. Show all posts
Showing posts with label community pediatrics. Show all posts

Tuesday, September 15, 2015

The Great Divide: Examining Social Determinants of Health

By: Joann Schulte  DO, MPH; Editorial Board Member  
       And they lived happily ever after.  Surely you've heard that phrase ending fairy tales or rags to riches stories.  The plot is basically poor boy or girl pulls himself or herself up by the bootstraps with minimal help from anybody else. That myth has endured ever since Horatio Alger started penning his stories in the 1890s.  The reality is that most people who make themselves a success have help along the way from parents, teachers or somebody who cared and took an interest.  Of course,  children who face adversity have dreams, but often have barriers that Horatio Alger just didn't mention.
     One factor that gets short shrift in such stories is how the hero or heroine started out. Specifics such as dealing with hunger or  having to worry about apartment infestations may not be described in detail in a hard luck story, but these issues are common in reality.  Basics like food insecurity, poor housing or a stressed out single parent are among the social determinants of health (SDH) that can crush a child's dreams early on.  The toxic stress model suggests that social determinants of health often disrupt normal physiological processes, get "under a child's skin" and put a child's future and dreams at risk.
       Pediatricians often try to help individual children who go hungry or live in rat infested housing.  One patient at a time is good, but doesn't fix a community.  Recently  innovative programs called Medical - Legal Partnerships have shown some success in addressing SDH on a  broader community scale.
      Research by Lovegrove,et al. (doi:10.1542/peds.2015-2092), published this month in Pediatrics, documents some successes achieved in Ohio.  That's where the Division of General and Community Pediatrics at Cincinnati Children's Hospital Medical Centers has paired with the Legal Aid Society of greater Cincinnati.  The partnership is between pediatricians and attorneys who have experience helping those trying to overcome their poverty status..
      The pediatricians, who provide care for 15,000 children, did an anonymous survey of parents asking what unaddressed needs their children had.   The survey found that 29 % of parents reported living in poor housing with conditions such as cockroaches or mold.  One in five parents reported financial problems limiting their abilities to buy medication for themselves.  Thirty percent of children lived in household where food insecurity was a problem and 15% of families with infants had to stretch their allotted formula to last long enough to get their next allotment.
      Working together, the physicians and attorneys who comprise  the Cincinnati Child Health Law Partnership (Child HeLP) have identified and improved a cluster of substandard housing  areas where problems included pest infestations, broken windows and water leaks.  They also worked  to provide sufficient formula through donations to food banks that helped more than 1,500 families feed their infants.
       The Cincinnati program and others like it often use Maslow's hierarchy of needs   to assess common needs.   The pyramid assesses human needs, starting at a physiological base with food and shelter and progressing to self actualization (see Figure).  The programs then implement community interventions that benefit multiple children and their families with these needs.  The article by Longrove et al. provide a good overview of a process that can link clinical and community resources in programs that can intervene in economic, environmental and psychosocial areas.  That's a good way to reshuffle at least part of the deck that is often stacked against children from poor families.  A better start to the story is more likely to produce a happy ending.

Related Links

Monday, January 5, 2015

The Importance of Being Earnest in Making Sure You Ask About Social Determinants of Health

By: Lewis First, MD, MS; Editor-in-Chief 
Courtesy of Donnie Ray Jones@Flickr

     The more we take into account a family’s unmet social needs, the better the outcome for the child—or so we understand based on a myriad of articles published over the past few years in our journal and others. Yet if we not only screen but refer families to community resources to meet those unmet needs, does it improve the health and wellbeing of those families?  
     Gang et al. (doi: 10.1542/peds.2014-2888) elected to address this question through a cluster randomized controlled trial involving eight urban community health centers where four centers asked mothers to complete a self-report of unmet family needs and then made referrals to assist in those needs—and four provided routine care.       
     The results are dramatic and well worth your attention in what happened to those families receiving the intervention. Do you ask about social determinants of health in your patients or better yet—make referrals to community agencies and resources once those determinants have been identified?   
     To help further stress the import of what this study suggests, Dr. Robert (Bob) Block, former AAP President and now newly named director of the AAP’s  Center on Child Health and Resilience provides an accompanying commentary (10.1542/peds.2014-3656) that further highlights the need to screen for social needs of families, make referrals and in turn increase the opportunities for strengthening resiliency in these families and most importantly their children. Read both the article and the commentary and if you are not screening for social determinants of health in your patients, you will hopefully do so as a result of what you learn.

Related Links:

Monday, December 29, 2014

The New Year Brings New Changes to Pediatrics

There has not been a year since becoming editor-in-chief that Pediatrics has not introduced changes in our journal to further its mission to provide valid and reliable information that will lead to better health outcomes for children—and this year is no exception.

Beginning with the January issue, our editorial board is delighted to welcome some new features into Pediatrics as well as some production changes to enhance the readability of our journal.

These are described in a Commentary (doi: 10.1542/peds.2014-3421) we are releasing online. New features include two new columns—one written and peer-reviewed by trainees through the AAP’s Section on Medical Students, Residents and Fellows in Training (SOMSRFT) and the other entitled: “Diagnostic Dilemmas and Clinical Reasoning” offers you a chance to work through a clinical situation with input from a variety of experts with the hope you can solve the case before those experts do.

From a production standpoint, beginning in January, we introduce a new interior design with cleaner, more open pages and a new font to make the journal even easier to read.

And if you are a social media user, we have changes planned for how we use our Facebook and Twitter sites that we highlight in the Commentary.

Our recent reader survey suggested that readers want even quicker access to new studies via print, web, and mobile devices. And our plans for the upcoming year may mean big changes for our print version as well as easier and more rapidly published access to studies and articles with whatever technology you have.

I could go on, but instead, I encourage you to read the commentary, check out the new features and changes and tell us what you think by responding to this blog, sending us an e-letter or posting a comment on our Facebook or Twitter sites.

Pediatrics belongs to all of us vested in child health—so thanks for the ongoing feedback as we continuously strive to improve the health of the young patients we care for.

Tuesday, September 30, 2014

The Role of Parenting & Home Stimulation in Overcoming Cognitive Deficits in Bangladesh

By: Lewis First, MD, MS; Editor-in-Chief 

Bangladeshi children. Photo by Mahmud Rassel via Flickr
Poverty certainly takes its toll on children's health given the association between poverty and cognitive deficit in infancy, but is it possible to improve this deficit with environmental and parental influence?

The answer is a resounding yes according to Hamadani et al. (doi: 10.1542/peds.2014-0694) who performed a longitudinal study of development in more than 2,800 infants in Bangladesh. They followed these infants for IQ changes over their first five years of life as impacted by such factors as parental education and home stimulation by parents. The results are impressive and stress the import of such factors in a way that can be generalizable to our own young patients born into poverty in this country.

To share even more lessons learned from this study, we invited Dr. Andrew Racine (doi: 10.1542/peds.2014-1375) to comment in an accompanying editorial that we are also early releasing this week.

Both the study and commentary are rich in take-aways that will be useful to you and the underserved families you care for.

Related Reading:

Thursday, July 24, 2014

Quality Improvement to Support Food-Insecure Families

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our August issue.

By: Alex Kemper, MD, MPH, MS 

Photo by Toshimasa Ishibashi via Flickr
Here are some startling facts from the US Department of Agriculture released in 2013:

  • 17.6 million households (14.5%) had food insecurity at some time during 2012. This is a stable number since 2008.
  • 3.9 million households with children were food insecure at some time during 2012.

There is ample evidence that food insecurity can have a profound impact on the development and wellbeing of children. Although pediatricians cannot solve this major problem alone, we are certainly not helpless. For example, we can advocate for policy to help families either individually or in partnership with the organizations that represent us, like the American Academy of Pediatrics. We can also work to actively identify families with food insecurity and refer them to available resources (e.g., government assistance programs, local food banks).

Today we are releasing a Quality Report by Dr. Andrew Beck and colleagues (doi: 10.1542/peds.2013-3845) demonstrating how a successful collaboration between pediatricians and community partners was developed to help food-insecure families and their infants have better access to infant formula, educational materials, and clinic and community resources.

Read this and be inspired. Do you know who in your practice faces food insecurity? What do you do to address the problem?

Related Reading: 

Wednesday, July 2, 2014

A Longitudinal Community Pediatrics Training Initiative for Residents: Did It Work?

By: Lewis First, MD, MS
Photo by FamilyMRW via Flickr

In 1999, the Dyson Foundation of Millbrook New York launched an initiative for ten pediatric residency training programs to redesign their programs to provide an immersive experience in community pediatrics in partnership with community-based organizations. The goal of the Community Pediatrics Training Initiative (CPTI) was to train residents to continue to involve themselves and advocate for the improvement of community child health long after they had finished their residency using the principles and practices learned as part of the CPTI curriculum. So did it work?

Minkovitz et al. (doi: 10.1542/peds.2013-3357), who oversaw the CPTI evaluation team, share follow-up data from a cross-sectional survey analysis of residents in the CPTI five years after they completed their residency as compared to comparably-aged respondents who did not train in CPTI designated programs. The results show success: CPTI graduates continue to do more community involvement and demonstrate better community advocacy skills than those in the comparison group.

To get a better idea of what graduates are doing and lessons learned from this program, read the study that we are early–releasing this week. Don’t pass up a terrific commentary by Chamberlain and Kaczorowski (doi: 10.1542/peds.2014-1130) that sheds much light on how these same skills learned can be generalized to the next generation of pediatricians (as well as to those of us still trying to get it right for children)!

Related Reading:

Saturday, May 31, 2014

A Five-Year Report from the Pediatric AIDS Corps

By: Lewis First, MD, MS

In 2005, the Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) created a global health corps—the Pediatric AIDS Corps (PAC) to provide clinical and educational programs to bring better AIDS care to parts of the world where it was most needed.
Students in the Central African Republic learning about HIV/AIDS
Photo by Pierre Holtz for UNICEF via Flickr

Schutze et al. (doi: 10.1542/ peds.2013-2938) have compiled five years’ worth of evaluative descriptive data combined with surveys of PAC physicians to help us better understand the importance of this remarkable program and the magnitude of its accomplishments in such a short period of time.

One comes away from this special article appreciating the global health work of the PAC and wanting to know more about how to expand its work even more—perhaps at a national level, given the positive outcomes being obtained. Journey with the PAC team by reading this five-year report and learning more.

Related Reading:

Wednesday, January 29, 2014

Improving Asthma Care for At-Risk Teens

Deputy Editor Dr. Alex Kemper offers a preview of a Quality Report being early released this week from our February issue:

Public Domain Photo via Wikimedia Commons
We all know that asthma is a common chronic illness that affects an estimated 7 million U.S. children. We also know that there are many adolescents, especially at-risk teens living in cities, whose asthma, despite our best efforts, is under poor control. From previous research, we know that by engaging adolescents to participate in self-management and coordinating community health resources, outcomes can be significantly improved. Is that possible in the “real world”?

Read the Quality Report by Dr. Britto and colleagues (doi: 10.1542/ peds.2013-0684) to find out! They implemented interventions for their patients guided by the Chronic Care Model focused on standardized and evidence-based care in an approach that emphasized care coordination and active outreach, self-management support, and community connections.

Could you replicate this in your community? Are the resources available? What would need to change? Participate in the conversation by leaving your comment below, on Facebook or via Twitter, or submit an eLetter to the authors at our website.

Related Reading:

Tuesday, December 10, 2013

Making a Big Difference in Communities All Over the Country: Catching up with the CATCH Program!

Photo by  geralt via Pixabay
The Community Access to Child Health (CATCH) Program that provides small seed grant-funding for pediatricians to improve the health of their communities was last evaluated in 1998. Since then, hundreds of CATCH grants have been awarded—and the question is: Have these grants made a difference?

You better believe they have—according to a special article by Soares et al. (doi: 10.1542/peds.2013-1471) being early released this week on the role of CATCH in our communities. The high numbers of projects funded, completed and sustained through community partnerships as a result of CATCH grants is inspiring.

“Catch” the CATCH spirit and read this article to better understand how a small investment can go a long way. If you haven’t applied for CATCH funding for the patients in your community, this special article may get you doing just that!

Monday, November 18, 2013

Is the Medical Home Reaching Out into Community Health Involvement?

The  need to link the medical home with community programs, services, and agencies has never been more important, and yet are we doing as good a job as we might engaging in community child health activities?

Photo by SurfaceWarriors via Flickr
Minkovitz et al. (doi: peds.10.1542/2013-1917) looked at how involved pediatricians are with their communities in 2010 compared to 2004 using two national surveys sent in the corresponding years. Unfortunately nowadays there is less formal training in community advocacy and this in turn appears to be influencing a decrease in community involvement. The authors provide other factors contributing or detracting from involvement, but I leave those up to you to read about.

Former AAP President Dr. Judith Palfrey (doi: peds.10.1542/2013-3096) provides her perspective on this issue in an accompanying commentary. Do you agree with the findings or feel there is more community involvement going on in this country than meets the eye or this study? Get involved and share your input below, via the journal’s Facebook page, or through Twitter (@Lewis_First).