Commmunity-based Advocacy Training – Strategies and Tools for Preparing Pediatricians to Meet the FutureCommmunity-based Advocacy Training – Strategies and Tools for Preparing Pediatricians to Meet the Future

Marsha Griffin, MD; Judith Livingston, MEd, MCHES; Ann Cass; Lily Gutnik, MD; Jessica Stroik, MDUTHSCSA Regional Academic Health Center/UTHSCSA Department of Pediatrics

Marsha Griffin, MD; Judith Livingston, MEd, MCHES; Ann Cass; Lily Gutnik, MD; Jessica Stroik, MDUTHSCSA Regional Academic Health Center/UTHSCSA Department of Pediatrics

Program Objective:Community for Children is an elective rotation designed to prepare future physicians to provide compassionate, effective leadership within community collaborations to advocate for the health of all children, including poor and immigrant children.

Target Populations:The primary target populations are residents and 4th year medical students participating in Community for Children, a 4-week international elective designed for participants to serve and learn from secondary target populations, the children, families and communities on the Texas/Mexico border.

Many of the families live in colonias, impoverished and unincorporated rural settlements along the border which lack basic infrastructure such as potable water and electricity. Colonias are among the poorest communities in the U.S. (US Census 2010).

Program Objective:Community for Children is an elective rotation designed to prepare future physicians to provide compassionate, effective leadership within community collaborations to advocate for the health of all children, including poor and immigrant children.

Target Populations:The primary target populations are residents and 4th year medical students participating in Community for Children, a 4-week international elective designed for participants to serve and learn from secondary target populations, the children, families and communities on the Texas/Mexico border.

Many of the families live in colonias, impoverished and unincorporated rural settlements along the border which lack basic infrastructure such as potable water and electricity. Colonias are among the poorest communities in the U.S. (US Census 2010).

Program Description:The Community for Children curriculum covers:

Rights of the Child Social Determinants of Disease & HealthClinical Care in Resource-poor RegionsImpact of Poverty, Immigration and ViolencePreparing for AdvocacyCultural CompetencyFostering a Culture of CompassionProfessional Development

Training includes workshops, community outreach, advocacy projects, tailored Spanish-language classes, guided reflection, individualized professional development counseling and on-going mentoring.

A key strategy is community-based advocacy training.Trainees partner with community-based

organizations (CBO) to develop, implement and evaluate advocacy projects. Trainees experience community at many levels, working with physicians, public health officials, social activists,

migrant refugee health experts, policymakers, lay community health leaders/promotoras and families.

Methods:For each rotation, trainees receive a synopsis of advocacy opportunities and identify the organizations with which they will work. They meet with CBO leaders to discuss needs and plan interventions.

Trainees conduct projects with CBO and CfC supervision. Examples of tools used:•Surveys/other data collection instruments •AAP Community-based Residents Projects Toolkit•CfC Guidelines for Preparing Abstracts Trainees present project results tofaculty, trainee cohort, CBO and community members.

CBO coordinators provide evaluation feedback to faculty on trainee and impact of trainee’s project. Reflection pieces, post-elective evaluations and 6-month follow-up interviews with trainees are also used to evaluate impact of the elective.

Program Results:Since September 2007, 44 trainees have participated in CfC,representing 23 medical schools and residency programs inthe U.S. and other countries.

Half of trainees interviewed 6-months post-training have continued advocacy work despite demands of residency training.

Sample Advocacy Project Identifying Barriers in Access to Health Care Among Residents in Hidalgo County Colonias

CfC trainees partnered with Proyecto Azteca, a nationally recognized, community-directed housing organization that has financed and trained more than 700 families in the construction and first-time home ownership in over 120 Hidalgo County colonias. The trainees:

• Conducted 3 focus groups on access to health care with key informants from target population.

• Developed and piloted questionnaire (Spanish/English)• Administered questionnaire door-to-door in 4 colonias;

clinic waiting rooms and in English-language classes • Entered data in MS Excel and performed basic statistical

analysis on 122 surveys completed.• Data revealed that despite living in the US for many years,

most survey respondents lacked fundamental knowledge about the US healthcare system and resources.

• CBO will use results to guide resource utilization and advocacy.

Conclusion: Understanding the social milieu and its impact on child health outcomes is paramount to effective advocacy. If physicians-in-training are to be able to address the millennial morbidities and prepare for a plausible future, they need structured opportunities to learn from and contribute to community-based work, outside the comfort of the clinical setting. The strategies and tools used in CfC are helping prepare future pediatricians to be compassionate leaders and effective advocates for children’s health.

Community for Children is a collaboration ofUTHSCSA Regional Academic Health Center and Department of Pediatrics, Brownsville Community Health Center, clinics and community-based organizations in Texas’ Lower Rio Grande Valley.

Details and application information at - http://www.communityforchildren.org

Top Five Reported Barriers to Health Care Access

23%

26%

47%

58%

73%

0.00% 100.00%

Wait time for appt

Transportation

Wait time at clinic

Lack of insurance

Cost of care

Students At the Border Wall