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Willing L, Schreiber J. Using Advocacy to Address the Crisis of Children's Mental Health. Child Adolesc Psychiatr Clin N Am 2024; 33:319-330. [PMID: 38823806 DOI: 10.1016/j.chc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Children and youth in the United States are experiencing a mental health crisis that predates the COVID-19 pandemic. Child and adolescent psychiatrists have the knowledge and skillset to advocate for improving the pediatric mental health care system at the local, state, and federal levels. Child psychiatrists can use their knowledge and expertise to advocate legislatively or through regulatory advocacy to improve access to mental health care for youth. Further, including advocacy education in psychiatry and child psychiatry graduate medical education would help empower child psychiatrists to make an impact through their advocacy efforts.
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Affiliation(s)
- Laura Willing
- Children's National Hospital and George Washington University School of Medicine, 6833 4th Street NW Washington, DC 20012, USA.
| | - Justin Schreiber
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, UPMC Children's Hospital of Pittsburgh, Lawrenceville Medical Building, 4117 Penn Avenue, 3rd Floor- 3111, Pittsburgh, PA 15224, USA
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Burnett JR, De Lima B, Wang ES, McGarry K, Kim DI, Kisielewski M, Manley K, Desai SS, Eckstrom E, Henry TL. How Are We Teaching Advocacy? A National Survey of Internal Medicine Residency Program Directors. J Gen Intern Med 2024:10.1007/s11606-024-08753-3. [PMID: 38710862 DOI: 10.1007/s11606-024-08753-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/29/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Although internal medicine (IM) physicians accept public advocacy as a professional responsibility, there is little evidence that IM training programs teach advocacy skills. The prevalence and characteristics of public advocacy curricula in US IM residency programs are unknown. OBJECTIVES To describe the prevalence and characteristics of curricula in US IM residencies addressing public advocacy for communities and populations; to describe barriers to the provision of such curricula. DESIGN Nationally representative, web-based, cross-sectional survey of IM residency program directors with membership in an academic professional association. PARTICIPANTS A total of 276 IM residency program directors (61%) responded between August and December 2022. MAIN MEASUREMENTS Percentage of US IM residency programs that teach advocacy curricula; characteristics of advocacy curricula; perceptions of barriers to teaching advocacy. KEY RESULTS More than half of respondents reported that their programs offer no advocacy curricula (148/276, 53.6%). Ninety-five programs (95/276, 34.4%) reported required advocacy curricula; 33 programs (33/276, 12%) provided curricula as elective only. The content, structure, and teaching methods of advocacy curricula in IM programs were heterogeneous; experiential learning in required curricula was low (23/95, 24.2%) compared to that in elective curricula (51/65, 78.5%). The most highly reported barriers to implementing or improving upon advocacy curricula (multiple responses allowed) were lack of faculty expertise in advocacy (200/276, 72%), inadequate faculty time (190/276, 69%), and limited curricular flexibility (148/276, 54%). CONCLUSION Over half of US IM residency programs offer no formal training in public advocacy skills and many reported lack of faculty expertise in public advocacy as a barrier. These findings suggest many IM residents are not taught how to advocate for communities and populations. Further, less than one-quarter of required curricula in public advocacy involves experiential learning.
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Affiliation(s)
- Joel R Burnett
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA.
| | - Bryanna De Lima
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Emily S Wang
- UT Health San Antonio Long School of Medicine, San Antonio, TX, USA
| | - Kelly McGarry
- Alpert Medical School at Brown University, Providence, RI, USA
| | - Daniel I Kim
- University of California, Riverside School of Medicine, Riverside, CA, USA
| | | | - Kelsi Manley
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Sima S Desai
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
| | - Elizabeth Eckstrom
- Oregon Health & Science University (OHSU) School of Medicine, Portland, OR, USA
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Boodoo R, Lagman JG, Eisele C, Saunders EFH. Highlighting Areas for Gun Violence Advocacy, as a Part of Medical Education in the USA. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:466-468. [PMID: 37651037 DOI: 10.1007/s40596-023-01846-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Ramnarine Boodoo
- Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | | | - Caroline Eisele
- Pennsylvania State University College of Medicine, Hershey, PA, USA
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Agrawal N, Lucier J, Ogawa R, Arons A. Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022. J Gen Intern Med 2023; 38:2792-2807. [PMID: 37340255 PMCID: PMC10507002 DOI: 10.1007/s11606-023-08244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Advocacy is an integral component of a physician's professional responsibilities, yet efforts to teach advocacy skills in a systematic and comprehensive manner have been inconsistent and challenging. There is currently no consensus on the tools and content that should be included in advocacy curricula for graduate medical trainees. OBJECTIVE To conduct a systematic review of recently published GME advocacy curricula and delineate foundational concepts and topics in advocacy education that are pertinent to trainees across specialties and career paths. METHODS We conducted an updated systematic review based off Howell et al. (J Gen Intern Med 34(11):2592-2601, 2019) to identify articles published between September 2017 and March 2022 that described GME advocacy curricula developed in the USA and Canada. Searches of grey literature were used to find citations potentially missed by the search strategy. Articles were independently reviewed by two authors to identify those meeting our inclusion and exclusion criteria; a third author resolved discrepancies. Three reviewers used a web-based interface to extract curricular details from the final selection of articles. Two reviewers conducted a detailed analysis of recurring themes in curricular design and implementation. RESULTS Of 867 articles reviewed, 26 articles, describing 31 unique curricula, met inclusion and exclusion criteria. The majority (84%) represented Internal Medicine, Family Medicine, Pediatrics, and Psychiatry programs. The most common learning methods included experiential learning, didactics, and project-based work. Most covered community partnerships (58%) and legislative advocacy (58%) as advocacy tools and social determinants of health (58%) as an educational topic. Evaluation results were inconsistently reported. Analysis of recurring themes showed that advocacy curricula benefit from an overarching culture supportive of advocacy education and should ideally be learner-centric, educator-friendly, and action-oriented. DISCUSSION Combining core features of advocacy curricula identified in prior publications with our findings, we propose an integrative framework to guide design and implementation of advocacy curricula for GME trainees. Additional research is needed to build expert consensus and ultimately develop model curricula for disseminated use.
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Affiliation(s)
- Nupur Agrawal
- Division of Internal Medicine and Pediatrics, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - Jessica Lucier
- Palliative Care Program, Division of General Internal Medicine & Health Services Research, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - Rikke Ogawa
- UCI Libraries, University of California Irvine, Irvine, CA USA
| | - Abigail Arons
- Division of General Internal Medicine, Department of Internal Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA USA
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Rafla-Yuan E, Moore S, Carvente-Martinez H, Yang P, Balasuriya L, Jackson K, McMickens C, Robles-Ramamurthy B. Striving for Equity in Community Mental Health: Opportunities and Challenges for Integrating Care for BIPOC Youth. Child Adolesc Psychiatr Clin N Am 2022; 31:295-312. [PMID: 35361366 DOI: 10.1016/j.chc.2021.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Supporting the mental health of youth who identify as Black, Indigenous, or Persons of Color (BIPOC) continues to be a challenge for clinicians and policymakers alike. Children and adolescents are a vulnerable population, and for BIPOC youth, these vulnerabilities are magnified by the effects of structural, interpersonal, and internalized racism. Integration of psychiatric care into other medical settings has emerged as an evidence-based method to improve access to psychiatric care, but to bridge the gap experienced by BIPOC youth, care must extend beyond medical settings to other child-focused sectors, including local governments, education, child welfare, juvenile legal systems, and beyond. Intentional policy decisions are needed to incentivize and support these systems, which typically rely on coordination and collaboration between clinicians and other stakeholders. Clinicians must be trauma-informed and strive for structural competency to successfully navigate and advocate for collaborative systems that benefit BIPOC youth.
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Affiliation(s)
- Eric Rafla-Yuan
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, #0851, San Diego, CA 92093, USA.
| | - Shavon Moore
- Department of Psychiatry, UC San Diego Health Psychiatry - La Jolla, 8950 Villa La Jolla Drive, Suite C101, MC 9057, La Jolla, CA 92037, USA
| | | | - Phillip Yang
- Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7985, San Antonio, TX 78229, USA
| | - Lilanthi Balasuriya
- Yale University School of Medicine, 333 Cedar Street, SHM IE-66, PO Box 208088, New Haven, CT 06510-8088, USA
| | - Kamilah Jackson
- PerformCare, 300 Horizon Drive Suit 306, Trenton, NJ 08691, USA
| | - Courtney McMickens
- North Carolina, Eleanor Health, 610 Pembroke Road, Greensboro, NC 27408-7608, USA
| | - Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7792, San Antonio, TX 78229, USA
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Rohrbaugh RM, DeJong SM. The Role of the Program Director in Supporting Diversity, Equity, and Inclusion. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:264-268. [PMID: 34272722 DOI: 10.1007/s40596-021-01474-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/27/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Sandra M DeJong
- Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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Balasuriya L, Isom J, Cyrus K, Ali H, Sloan A, Arnaout B, Steinfeld M, DeSouza F, Jordan A, Encandela J, Rohrbaugh R. The Time Is Now: Teaching Psychiatry Residents to Understand and Respond to Oppression through the Development of the Human Experience Track. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:78-83. [PMID: 33512693 DOI: 10.1007/s40596-021-01399-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Affiliation(s)
| | | | - Kali Cyrus
- Johns Hopkins Medicine, Baltimore, MD, USA
| | - Hana Ali
- Yale School of Medicine, New Haven, CT, USA
| | | | - Bachaar Arnaout
- Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | | | - Flavia DeSouza
- Yale School of Medicine, New Haven, CT, USA
- Howard University, Washington, DC, USA
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