Exploring the scope for advocacy by paediatricians

Pediatrician and parental evaluation of child neurodevelopment at 2 years of age

BACKGROUND

The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes. Screenings should be carried out by combining the family pediatricians' and parents' perspectives, the two fundamental sources of information on children's health. The present study has three aims: (a) to test the feasibility of parent-report instruments to detect warning signs in their children's development; (b) to ascertain whether there is an agreement between the family pediatricians' (FP) clinical judgments of warning signs and the parental perceptions; (c) to determine whether there is a link between parents' distress and child development.

METHODS

Within the NASCITA birth cohort, in addition to the family pediatrician's clinical evaluation with routine tools, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) was completed by parents to assess the child's language, social skills, behavior, and sensory areas. Parents were also asked to complete the Parenting Stress Index, Short Form (PSI-SF) to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs.

RESULTS

The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the pediatrician's assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR 2.46, 95%CI: 1.23-4.91) and having sleep disorders (OR 2.43, 95% CI 1.17-5.04) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed (OR = 3.14; 95% CI 1.60-6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27-4.37).

CONCLUSIONS

Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.

Going Farther by Going Together: Collaboration as a Tool in Advocacy

With greater understanding of the impact of social determinants on child health, advocacy has become essential to promoting children's health, particularly at the population level. Successful advocacy requires coalition building. Steps on how to create a productive coalition, including the selection of partner organizations, understanding how these groups enhance your activities, and strict definition of assigned roles is reviewed. Examples of successful coalitions are reviewed. A list of potential partners, who focus on various aspects of child health, is provided.

Advancing Advocacy: Implementation of a Child Health Advocacy Curriculum in a Pediatrics Residency Program

INTRODUCTION

ACGME program requirements for graduate medical education state that pediatric residency programs should include elements of child advocacy education. Finding readily available, easily implementable advocacy curricula for pediatric residency programs is challenging. We conducted a generalized curricular needs assessment via literature review and a targeted needs assessment with health care providers and advocacy leaders and developed and implemented a child health advocacy curriculum in a pediatrics residency program.

METHODS

Delivered across 9 months, the curriculum included three components: electronic resources, didactic sessions, and interactive workshops aimed at developing advocacy skills in the context of pressing child health issues. The learner audience was PGY 1 through PGY 4. The curriculum was evaluated using pre- and postcurriculum surveys.

RESULTS

Our curriculum advanced child advocacy locally by establishing partnerships with state and federal American Academy of Pediatrics and pediatric residency programs, teaching residents to generate advocacy action plans, and implanting a longitudinal advocacy curriculum in the residency program. Sixty-four of 70 residents participated in the curriculum: 33% were PGY 1, 31% were PGY 2, 30% were PGY 3, and 6% were PGY 4. Pre- and postcurriculum surveys demonstrated improved knowledge of and comfort level with advocacy after curriculum completion.

DISCUSSION

Child advocacy teaching improved resident and faculty awareness about child health issues in the community, as well as understanding of pathways to advocate for child health. The curriculum is reproducible and feasible and can assist other institutions to develop advocacy education and skill development programs.

Predicting Patient Advocacy Engagement: A Multiple Regression Analysis Using Data From Health Professionals in Acute-Care Hospitals

Although literature documents the need for hospital social workers, nurses, and medical residents to engage in patient advocacy, little information exists about what predicts the extent they do so. This study aims to identify predictors of health professionals' patient advocacy engagement with respect to a broad range of patients' problems. A cross-sectional research design was employed with a sample of 94 social workers, 97 nurses, and 104 medical residents recruited from eight hospitals in Los Angeles. Bivariate correlations explored whether seven scales (Patient Advocacy Eagerness, Ethical Commitment, Skills, Tangible Support, Organizational Receptivity, Belief Other Professionals Engage, and Belief the Hospital Empowers Patients) were associated with patient advocacy engagement, measured by the validated Patient Advocacy Engagement Scale. Regression analysis examined whether these scales, when controlling for sociodemographic and setting variables, predicted patient advocacy engagement. While all seven predictor scales were significantly associated with patient advocacy engagement in correlational analyses, only Eagerness, Skills, and Belief the Hospital Empowers Patients predicted patient advocacy engagement in regression analyses. Additionally, younger professionals engaged in higher levels of patient advocacy than older professionals, and social workers engaged in greater patient advocacy than nurses. Limitations and the utility of these findings for acute-care hospitals are discussed.

How can medical schools contribute to bringing about health equity?

The role of medical schools is in a process of change. The World Health Organization has declared that they can no longer be ivory towers whose primary focus is the production of specialist physicians and cutting edge laboratory research. They must also be socially accountable and direct their activities towards meeting the priority health concerns of the areas they serve. The agenda must be set in partnership with stakeholders including governments, health care organisations and the public. The concept of social accountability has particular resonance for the Bar Ilan Faculty of Medicine in the Galilee, Israel's newest medical school, which was established with a purpose of reducing health inequities in the Region. As a way of exploring and understanding the issues, discussions were held with international experts in the field who visited the Galilee. A symposium involving representatives from other medical schools in Israel was also held to extend the discourse. Deliberations that took place are reported here. The meaning of social accountability was discussed, and how it could be achieved. Three forms of action were the principal foci - augmentation of the medical curriculum, direct action through community engagement and political advocacy. A platform was set for taking the social accountability agenda forward, with the hope that it will impact on health inequalities in Israel and contribute to discussions elsewhere.

Human rights and child health

Human rights are those basic standards without which people cannot live in dignity. Children are at risk of human rights violations because of their vulnerability in society. The Convention on the Rights of the Child (CRC), a United Nations (UN) treaty acknowledges that addressing children's human rights requires special attention. In Australia groups such as children seeking asylum, Aboriginal and Torres Strait Islander children, children with disabilities, children in care and children living in poverty are identified to be at particular risk. As individuals and collectively, we have had a long history of gathering information, advocacy and tailoring training to improve children's health and well-being. A human rights approach and the use of the CRC provide an additional framework to do this.

Pediatricians advocating for children: an annotated bibliography

PURPOSE OF REVIEW

Pediatricians have for many years been strong advocates for the health and safety of children. This article reviews the health literature to provide a historical perspective of advocacy efforts of pediatricians and examples of advocacy for patients at the bedside, in the community, and through local, state, and federal legislation, as well as policymaking. Studying these advocacy activities and incorporating them into pediatric practice and education of residents will surely result in stronger, healthier, safer, and happier children and families.

RECENT FINDINGS

Some of the cited works relate to pediatric advocacy in general, and some relate to advocacy for specific pediatric topics. Also, articles relating to the education of medical students and pediatric residents are reviewed; they may be of benefit to educators who develop advocacy curriculum.

SUMMARY

A review of the MEDLINE literature database from 1966 through October 2003 was performed looking for the terms advocacy (child advocacy, consumer advocacy, legislative advocacy, patient advocacy), as well as advocacy education and training, and was limited to children from birth through 18 years. The titles and many of the abstracts of 4580 articles were reviewed, and 104 articles were read in full. From these, 68 were selected for review here; they were thought to be of particular interest to practicing pediatricians and pediatric educators.

Pediatric advocacy

Advocacy is part of the job description of a pediatrician. There is a long history of pediatrician involvement in civil society. Like other skills in pediatrics, the skills required for advocacy activities are learnable. Anyone who can learn the Krebs cycle can learn how to be a child advocate. Being a child advocate is not always easy, but it is rewarding. The 1995 Nobel Prize in Chemistry was awarded to Rowland et al for their work in the description of the destruction of stratospheric ozone by chlorofluorocarbons. Having done the groundbreaking research, Rowland and Molina spent much time working to ban chlorofluorocarbons. When asked why they, as bench scientists, ventured out of the laboratory as advocates, Rowland stated, "If not me, who? If not now, when?" (personal communication, December 7, 2000).