Advocacy for Children’s Health and Social Justice on the Texas/Mexico BorderAdvocacy for Children’s Health and Social Justice on the Texas/Mexico Border

Marsha Griffin, MD; Minnette Son, MD; Stanley Fisch, MD; Judith Livingston, MEd, MCHES; Catherine Monserrat, PhD UTHSCSA Regional Academic Health Center/UTHSCSA Department of Pediatrics

Marsha Griffin, MD; Minnette Son, MD; Stanley Fisch, MD; Judith Livingston, MEd, MCHES; Catherine Monserrat, PhD UTHSCSA Regional Academic Health Center/UTHSCSA Department of Pediatrics

Program Objective:Community for Children is a four-week elective rotation on the Texas/Mexico border 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.

Residents and 4th year medical students in Community for Childrenserve and learn from children, families and communities.

Many of these 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 a four-week elective rotation on the Texas/Mexico border 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.

Residents and 4th year medical students in Community for Childrenserve and learn from children, families and communities.

Many of these 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, identified through

needs assessments and conducted in collaboration with CBO and faculty supervisors. Trainees also receive instruction on the legislative process and strategies for impacting public policy.

Faculty work with CBO leaders to identify potential projects of benefit to the community. Trainees spend a minimum of 45 hours doing advocacy. CfC has established strong partnerships with ten CBO, all of which serve poor and immigrant families on the border.

Student 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.• 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 used results to guide resource utilization and advocacy.

Community for Children is a collaboration of UTHSCSA Regional Academic Health Center and Department of Pediatrics, Brownsville Community Health Center, clinics and community-based organizations in Texas’ Lower Rio Grande Valley. Initial development was made possible, in part, through an AAP CATCH Residency Training Grant.

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

Discussion:Since September 2007, 47 trainees have participated in CfC, representing 26 medical schools and residency programs in the U.S., Canada and Israel. The majority of trainees interviewed 6-months post-training have continued advocacy work in their own communities. All trainees have expressed a deeper understanding of the social milieu of the children and families served.

Understanding the social milieu and its impact on child health outcomes is paramount to effective advocacy. The strategies and tools used in CfC are helping prepare future pediatricians to be compassionate leaders and effective advocates for children.

Student Advocacy Project Youth Civic Engagement

Proyecto Juan Diego (PJD) is a CBO working in the poorest colonia in the nation. Emphasis is on family health, education and immigrant issues.  They asked CfC students to survey community youth, ages 16-23, regarding what they believe are serious issues facing youth in the community. In collaboration with PJD and Brownsville ISD administrators, the CfC students developed a survey and translated it into Spanish.

While awaiting other approvals to implement in Brownsville ISD, the students surveyed 300 UT-Brownsville students (ages 18 and above) and 150 students in a parochial high school which approved the activity. CfC studentscompiled and presented their findings to PJD leadership which continued with BISD surveys (N=1000) after the rotation. Youth from CBO met with community leaders and politicians to outline their concerns and recommendations, based on survey data.

Visit the Community for Children web site at http://www.communityforchildren.org

The consensus among CBO and families they serve is that CfC makes a significant, positive and lasting contribution to their communities."Community for Children is a unique program that brings intelligent and compassionate medical professionals to the Rio Grande Valley. It has been very rewarding to meet these young doctors and help teach them about the reality of unaccompanied immigrant and refugee children held in the Rio Grande Valley. We are fortunate to have an ongoing relationship with this program and hope it continues to thrive and continue to attract the best and brightest doctors and medical students.” — M.,South Texas Pro Bono Asylum Project

For CfC students, the experience has been life-changing:“The experience in Community for Children was a critically transformative month for me. I am grateful that this kind of opportunity exists.” — S., Johns Hopkins-Baltimore

“Community for Children helped us to achieve competency as advocates on multiple levels. The things I experienced during this elective lit a fire in me to take up new crusades for children’s and adults’ rights, including health care.” — J., Christiana Care-Delaware

Student Advocacy Project Amnesty for Minor Detainees

Students’ research and advocacy work supported efforts of attorneys to provide legal services to unaccompanied, undocumented minors held in federal detention centers. Students were instrumental in helping attorneys obtain amnesty for detainees who were ultimately united with family members in the U.S.

Students At the Border Wall

“During the rotation, I learned how important it is to walk in the shoes of your patients. For community advocacy, I learned how much power doctors have to affect change and how important it is to collaborate with others.” — Y., Mount Sinai