The Anne E. Dyson Community Pediatrics Training Initiative

Columbia University

Children’s Hospital of New York

Harlem Hospital Center

Dodi Meyer, Milagros Batista, Ellen Lee

Goals and Objectives

1) To train residents to become lifelong advocates for children and communities

2) Enhance community service through partnerships with CBOs

3) Strengthen and expand the core community pediatric faculty

4) Strengthen and expand multidisciplinary collaborations

Communities of Northern Manhattan

• Assets– People– Agencies/ Institutions

• Needs– Poverty– Multiple unmet health needs

Residency Programs

• Children’s Hospital of New York– Voluntary Hospital/

Tertiary Care Center

– 60 residents

• Harlem Hospital Center– City Hospital– 20 residents

Core competencies

• Community Health

• Cultural competency

• Child Advocacy

COMMUNITY PEDIATRICS

COLUMBIA UNIVERSITY

G rand R ounds

C ontinu ity C lin ic Lectures

W orkshops

C ore Lecture Series

DIDACTICS

Ind iv idual P ro ject

Shopp ing Trips

AD VO C AC Y PR O JEC T

PROJECTS

Project D O C C

Parenting C lasses

Incarnation C hildren 's C enter

Safety C ityPS 128/Traffic Safety

La Leche League

Post-Partum C lasses

D om estic V io lence C enter

H om e V is its

W IC

V is iting N urse Serv ice (VN S)

Best Beg innings

COM M UNITY-CAM PUS PARTNERSHIPSSERVICE-LEARNING

M ETHODOLOGY OF LEARNING

Service Learning at Columbia:Identifying partners/ Best Beginnings

• Home visitation program/Primary prevention

• Partnership: Alianza Dominicana/ Columbia University/ School of Public Health/ NY Society for Prevention of Cruelty to Children

• Medical home: community based primary care site

Service Learning at Columbia: Learning Objectives

• Residents– Identify the cultural barriers that exist between

patient and and health care providers

• Family case workers– Describe the institutional culture of the medical

center

Service Learning at Columbia: Service Objectives

• Residents– Teach family case workers topics in general

pediatrics– Perform home visitations / delivery of primary

care

• Family case workers– Teach residents local health beliefs– Discuss community perception of the medical

center

Service Learning at Columbia: Structured Reflection

• Performed jointly by community and academic preceptors

• Targeted to both residents and family case workers

• What? So what? Now what?

Service Learning Potential Outcomes: Academic Perspective

• Builds community-oriented competencies

Service Learning Potential Outcomes: Academic Perspective

• Builds community-oriented competencies

• Enhances attitudes/ behaviors in health professionals

Service Learning Potential Outcomes: Academic Perspective

• Builds community-oriented competencies

• Enhances attitudes/ behaviors in health professionals

• Enhances service delivery/access to vulnerable populations

Service Learning Potential Outcomes:Academic Perspective

• Builds community-oriented competencies

• Enhances attitudes/ behaviors in health professionals

• Enhances service delivery/access to vulnerable populations

• Improves community/academic relations

Service Learning Potential Pitfalls: Academic Perspective

• Effective partnerships are labor intensive

• Needs to be realistic in service and learning outcomes: change doesn’t follow a semester plan

Service Learning Implementation Challenges: Academic Perspective

• Trust between academic center –community– History of town/gown relationships

• Buy in at a departmental/institutional level

• Buy in at a resident level

• Curriculum already overloaded

Service Learning Potential Outcomes: Community Perspective

• Improves practice / Potential community practitioners

• Enhances use of health practice

– Family feeling back at home, “back to the good old days”

– Friendly, people-centered, individualized care

Service Learning Potential Outcomes: Community Perspective

• Improves scope of knowledge in the health field

• Orients, teaches, and empowers staff to teach residents

• Opportunity to grow and develop

• Values the relevance of popular knowledge and culture

Service Learning Potential Pitfalls: Community Perspective

• Time intensive / Labor intensive

• Financial incentives need to be balanced

Service Learning Implementation Challenges: Community Perspective

• Buy in from leaders and grass root workers at the community-based organization level

• Build trust between families and institution

– Create a mediator

• Maintain the work flow

• Not only one way of learning

– Teaching and learning can happen at the same time

Service Learning Potential Outcomes: Resident Perspective

• Enhances health care delivery by improving understanding of community, including its resources

• Develops sense of involvement in community

• Provides opportunities to teach/learn in different contexts

Service Learning Potential Pitfalls:Resident Perspective

• Relationship with CBOs is not longitudinal

• Given limited time at each CBO, experiences may be highly variable

Service Learning Potential Challenges:Resident Perspective

• Need dedicated time for discussion about experiences with CBOs

• Learning how to utilize community resources appropriately

• Finding models of service-learning

Competency

Explain how beliefs, culture and ethnic practices can influence health status and health care for children in the community