The mission of the Community Pediatrics and Advocacy Program (CPAP) is to teach residents to become pediatricians who:
- Are as comfortable and competent in their role as child advocates, as they are in their medical practice.
- Effectively advocate for an individual child and family, as well as all children in their community on a city, state, regional and national level.
- Work in partnership with community-based agencies to promote the well-being of children.
- Create an expanded focus on community-based pediatrics and advocacy throughout the Hospital.
In cooperation with community partners, and based on the medical model of teaching (observe, learn, practice skills, then teach), CPAP combines didactic presentations and practical, interactive educational opportunities with independent and increasing community-based work as more advocacy skills are acquired. Community practice of medicine in the primary care centers continues throughout the residency with a strong advocacy base to frame the experience.
A four-week block of time in each year of residency is dedicated to the integration of advocacy and community pediatrics. In the intern year during the Development-Advocacy rotation, residents begin to acquire advocacy skills as they learn about community resources, begin to problem-solve medical cases that involve education and disability law and visit the homes of patients.
The Adolescent-Advocacy rotation for second-year residents provides opportunities to use learned advocacy skills by teaching in elementary schools, juvenile detention facilities, and observing the dependency and child welfare system.
Third-year residents lead advocacy campaigns prior to Pediatric Grand Rounds, take charge of leading the Advocacy Journal Club during their assigned rotation, and are prepared to develop an Advocacy Project of their own which is presented at a CPAP Advocacy Noon Conference poster session.
How do we define advocacy for a pediatrician?
Child advocacy is the active support of ideas, strategies or actions that seek to improve the health and well-being of individual children or adolescents, their families and communities. The goals of child advocacy include:
- Achieving social justice for youth
- Empowering families
- Assisting communities to support the healthy development of children and adolescents
Advocates work to affect the condition of an individual, either directly or indirectly, by fostering the health of families, communities, and populations.
Children and adolescents need strong advocates. They cannot vote, have no political voice, and often have little or no control over their environments. Child and adolescent morbidities have specific biological and behavioral determinants. Advocates who truly understand children are needed to maintain and enhance vital health and educational services, resources, and entitlements. Public policy and legislative advocacy are needed to address system-level problems on the local, state and federal level.
Pediatricians, regardless of specialty, advocate for children and adolescents every day. The American Academy of Pediatrics defines pediatricians as physicians who strive to attain optimal physical, mental, emotional, and social health and well-being for all infants, children, adolescents and young adults. Pediatricians have a unique opportunity to address all aspects of health and wellness that cannot be achieved by medical treatment alone.
Senior Advocacy Projects
Senior Advocacy Projects are the capstone of the CPAP curriculum and training.
Development and completion of a Senior Advocacy Project provides residents with an opportunity to apply advocacy skills and lessons learned throughout residency to achieve “real life” community advocacy.
Every project will be different due to the unique contribution of the residents. Residents may decide to work alone or in pairs or groups, within or across rotations. Some residents will choose their project based on a particular advocacy skill they want to improve and further develop, while others base their projects on an advocacy issue of interest identified either through CPAP or as life work. It is possible for residents to develop their own project, or advance an ongoing project with additional advocacy goals and objectives.
Examples of Senior Advocacy Projects
The Pediatric Education for Pre-hospital Professionals Curriculum
Project by Aaron Wallman-Stokes, MD, and Elon Fernandez, MD
This advocacy project, in partnership with the Philadelphia Fire Department, aims to increase comfort and success with pediatric assessment, stabilization and intervention in the field, with the goal of improving patient outcomes for children. Although pediatric patients represent a relatively small fraction of emergency medical calls/transports, the techniques and tools specific to pediatric resuscitation are instrumental in improving outcomes for children. This collaboration between Philadelphia pediatric providers and pre-hospital professionals (EMTs, paramedics, and fire fighters) is now in its fourth year, and continues to evolve to meet the needs of the EMT/PHP community, as well as to take advantage of the skills and interests of the pediatric providers.
To date, this advocacy project has provided annual sessions combining didactics and case examples with hands-on skill sessions, including a session on child maltreatment. As the project moves forward this year, the hope is to incorporate more hands-on stations, and potentially to divide sessions by the training level of the participants (for example, by offering a BLS-based and ALS-based session). Not only are residents advocating for some of the most vulnerable of pediatric patients, they are also enhancing their teaching skills in collaboration with non-MD medical professionals.
Transplant Medicine and Organ Donation Awareness
Project by Monique Gardner, MD
During her cardiology rotation, Dr. Gardner encountered patients who had received, or who were awaiting, heart transplantation. In some cases, there was not enough time for dedicated teaching about this patient population. In addition, she wanted to learn more about liver, lung and kidney transplant patients receiving care at CHOP. Many of Dr. Gardner’s co-residents were also interested in hearing more about her experiences with this unique patient population. To help increase the knowledge base around transplants and organ donation, Dr. Gardner created a transplant medicine elective with the help of Sam Goldfarb, MD, and Beth Rezet, MD.
To create an easy-to-use resource of residents, she developed Transplant Medicine Quick Guides for each of the solid organs: lung, liver, heart and kidney. These guides followed a universal format that included introductory topics for each of the organs. The guides were reviewed by specialists in each of the respective fields. The guides are now posted in the resident workrooms for easy accessibility, and published in the Intern Survival Guide. In the future, these guides can be edited and expanded upon for continued use.
This project eventually expanded beyond the residency program. As part of Organ Donation Awareness Month in April 2014, information regarding organ donation was distributed prior to Pediatric Grand Rounds. The handout included statistics about patients awaiting organ transplantation, as well as those who could be helped through the gift of organ donation.
Increasing Interest and Participation in Summer Camps for Children with Chronic Diseases
Project by Ricki Carroll, MD
Over the summers of 2013 and 2014, Dr. Carroll volunteered as medical staff at Dragonfly Forest Camp. As a camp physician, her role included administering medications, treating minor illness and injuries and triaging more severe ones.
The camp, located 45 minutes from CHOP, serves children with chronic medical conditions including sickle cell disease, hemophilia, chromosome 22q.11 deletion, asthma and autism. The mission of Dragonfly is to “provide an exhilarating, challenging, and nurturing camp experience through which children gain a greater sense of independence, self-esteem and self-reliance.” The camp accomplishes these goals by integrating peer support and outdoor adventure with high quality medical care, supervision and education.
Dr. Carroll wanted to do more than just volunteer. She wanted to get her CHOP colleagues involved, too. Based on a needs assessment her former resident colleagues had performed, Dr. Carroll was able to identify staffing needs and define the role of medical personnel. Medical camps such as Dragonfly cannot exist without volunteer medical staff. Recruiting medical volunteers, especially physicians and nurses, had been especially challenging.
There had been efforts to connect the Getaway coordinators with nurse managers from the emergency department and the hematology floors to recruit nurses. To recruit physicians, Dr. Carroll worked with the residency program to create a formalized elective and presented the project at the Advocacy Noon Conference.
There were eight CHOP residents in the summer of 2014 who spent one or more days volunteering at Dragonfly Forest Camp. The summer of 2015 was even more successful, with multiple nurses, respiratory therapists, and four attending physicians from CHOP joining the team. The number of volunteers continues to increase, due, in part, to the enthusiastic efforts of this resident-led team, who are making plans to ensure 2016 is the most successful year to date.
Pertussis Vaccination of Infant Caregivers in the Pediatric Office Setting
Project by Lisa Akhtar, MD, PhD, and Emily Duffy, MD, with faculty Kristen Feemster, MD, MPH, and Andrea McGeary, MD
Pertussis infection, which is a vaccine-preventable disease, causes a severe respiratory illness in young infants. However, the infants at highest risk of severe disease and death are too young to be vaccinated. Therefore, the American Academy of Pediatrics recommends that the youngest infants be protected via a “cocooning” strategy, by immunizing all infant contacts against pertussis including parents, grandparents, siblings, and out-of-home caregivers. However, many barriers to adult vaccination exist that limit the effectiveness of this “cocooning” strategy.
Drs. Akhtar, Duffy, Feemster, and McGeary wanted to learn more about these barriers to infant caregiver vaccination in order to better protect the most vulnerable infants in our community against pertussis.
To address this problem, this team of residents and attending physicians organized a needs assessment of the local population to determine what the critical barriers to infant caregiver vaccination are, and what mechanisms could be used to overcome them. They found that the majority of caregivers would not be willing to present to a local retail pharmacy for vaccination even if vaccination was free of charge. The data suggested that ensuring convenience is the key to increasing infant caregiver vaccine uptake, and that offering vaccination in the pediatric office setting may be an effective mechanism for overcoming barriers to convenience.
In the fall of 2014, Drs. Dalembert, Kallem and Martin began a pilot project to determine whether offering caregiver pertussis vaccination in the pediatric office setting was sufficient to increase caregiver vaccine uptake the West Philadelphia community.
The pertussis vaccination is now offered to all unimmunized adult caregivers presenting to the CHOP Cobbs Creek primary care office for the initial newborn visit over a one-month period. The team also collected information on how willing caregivers were to receive vaccination and what barriers are still present. Funding was obtained to offer vaccination free of charge from the CHOP Cares Community Fund.
This pilot study has provided valuable information regarding the feasibility and acceptability of offering pertussis vaccination in the pediatric office setting as a potential strategy to overcome barriers to infant caregiver vaccination. The resident team is hoping to pilot this program in the other resident-led primary care clinics at Karabots and South Philadelphia. Drs. Dalembert, Kallem and Martin presented their work at the Eastern Society for Pediatric Research in Philadelphia, PA, and also at the Pediatric Academic Societies (PAS) poster session in San Diego, CA.
The Community Pediatrics and Advocacy Program (CPAP), in conjunction with community partners, has conducted advocacy campaigns prior to Pediatric Grand Rounds since 2002. Since 2008, third-year residents lead the Grand Rounds Advocacy Campaign Initiative during their advocacy rotation. Advocacy campaigns demonstrate to the residents, faculty and hospital staff that child advocacy can be accessible and time-efficient. With prepared fact sheets and sample letters to government officials, we are making a difference for patients and families.
Advocacy campaigns are designed to:
- Encourage (and make it easy for) all hospital staff to sign/address letters to government officials about a timely child advocacy issue; or
- Enhance awareness about an important advocacy issue directly affecting children, families and the community-at-large
Graduate Education Committee (GEC)
At CHOP, our Graduate Education Committee (GEC) serves to review the educational aspects of the various rotations experienced by our pediatric resident trainees.
The committee is comprised of faculty education liaisons from the various divisions in the Department of Pediatrics and the Department of Critical Care. The resident committee members are representative of their training year class (five to six per class) from the categorical pediatrics program, peds-neurology, peds-genetics and medicine-pediatrics training programs (two representatives). Each of the division chiefs also sits on the committee.
Although specific rotations are reviewed at each meeting, the focus of the meeting concentrates on common themes, tested solutions and shared suggestions for improvement. The GEC also serves as Faculty Advisory Council, along with resident participation, as an annual review of the program.