Section on Medical Students Resident and Fellowship Trainees (SOMSRFT)

Advocacy Campaign 2014-2015

SOMSRFT Annual Advocacy Campaign

AAP Section on Medical Students, Residents and Fellowship Trainees (SOMSRFT) annual campaign focused on advocacy.

Provides a framework for YOU to get involved, learn about advocacy, and implement an advocacy project of your own.

Past SOMSRFT Advocacy Campaigns

2013/2014: P.A.V.E. the Way to Firearm Injury Prevention

2012/2013: Read, Lead, Succeed2011/2012: Vote for Kids2010/2011: Childhood Obesity2009/2010: ImmuneWise2008/2009: Tobacco Cessation

Why Focus on Poverty?

Poverty is a MEDICAL issue Poverty is a significant determinant of child health. Children living in poverty have poorer access to quality healthcare and worse health outcomes. Families living in poverty have higher infant mortality, greater risks for developmental delays, asthma, ear infections, obesity, poor nutrition, and child abuse and neglect. Child poverty adversely impacts health into adulthood.

2.AAP Agenda for Children Strategic Plan Poverty and Child Healthhttp://www.aap.org/en-us/about-the-aap/aap-facts/AAP-Agenda-for-Children-Strategic-Plan/Pages/AAP-Agenda-for-Children-

Strategic-Plan-Poverty-Child-Health.aspx

What exactly is poverty?

$23,850/year for a family of 4Does not vary based on geographic differences or cost of living.

Outdated: the manner in which “poverty” is calculated has not been updated since its inception in 1969.

Does not account for many of the expenses (nor the benefits) many families incur/receive.

3. US Department of Health and Human Services. Office for the Assistant Secretary for Planning and Evaluation. 2014 Poverty Guidelines. http://aspe.hhs.gov/poverty/14poverty.cf

4. Gabe T. Poverty in the United States: 2012. Congressional Research Service Report to Congress. November 13, 2013

Who Lives in Poverty?

Nearly half of ALL children live in poor/low‐income households.

These families have difficulty accessing health care and meeting the basic needs crucial for healthy child development.

In the U.S. in 2012:o 22% of children <18 lived in poverty

o (16 million children)

o 45% of children <18 lived in low‐income households

o (32.7 million children)2.AAP Agenda for Children Strategic Plan Poverty and Child Healthhttp://www.aap.org/en-us/about-the-aap/aap-facts/AAP-Agenda-for-Children-Strategic-Plan/Pages/AAP-Agenda-for-Children-Strategic-Plan-Poverty-Child-Health.aspx

Racial Disparities in Poverty

Kids Count Data Center. Children In Poverty By Race And Ethnicity http://datacenter.kidscount.org/data/Line/44-children-in-poverty-by-race-and-ethnicity?loc=1&loct=1#1/any/false/868,133,35,17,15,13,11/asc/10,11,9,12,1,185/323

Suburban Poverty

Most pediatricians will care for low‐income/poor families.

o Economic insecurity impacts a diverse child population, including children in suburban, urban, and rural communities.

o Since 2008, suburbs have experienced the largest and fastest increase of poor populations.

2. AAP Agenda for Children Strategic Plan Poverty and Child Health http://www.aap.org/en-us/about-the-aap/aap-facts/AAP-Agenda-for-Children-Strategic-Plan/Pages/AAP-Agenda-for-Children-

Strategic-Plan-Poverty-Child-Health.aspx#sthash.tdT6ZhOQ.dpuf

Poverty as a Medical Issue

Poor educational outcomes: poor academic achievement, higher rates of HS dropout.

More high risk behaviors: Early unprotected sex with increased teen pregnancy, Drug and alcohol abuse, Increased criminal behavior as adolescents and adults.

Increased exposure to “toxic stress”: impacting memory, educational attainment, exaggerated response to stress, and more high risk behaviors.

–Increased inflammatory markers leading to adult CV disease.

FACE Poverty

F: Food security/nutritionA: Access C: CommunityE: Education

Food Security, Nutrition and Obesity 14.6% of US households in 2008 were food insecure (unable to obtain adequate food). Among households with children it was 21%.

45% of low income families are food insecure

What is “adequate food?” Food insecurity can be assessed with the HFSS or the “Hunger Vital Signs.”

31% greater odds of being hospitalized since birth.

76% greater adjusted odds of being at increased developmental risk.

90% greater adjusted odds of being in fair/poor health (versus good/excellent health).

Food Security, Nutrition and Obesity

Food Security, Nutrition and Obesity

How do you FACE food insecurity?

Locally:o At the clinic: Check the Hunger Vital Signso Encourage patients to sign up for WIC and SNAP

o Provide information about local food banksState:

o Encourage summer lunch programsNationally:

o Lobby and promote the Healthy School Lunch bill

o Advocate for continued SNAP funding and enhanced SNAP benefits for immigrant families

Access Increasing access to patient centered medical homes helps alleviate the effects of poverty on children.

Medical home is an approach to providing primary care that is accessible, continuous, comprehensive, family‐centered, coordinated, compassionate and culturally effective.

Outcomes:o Improved healtho Improved well-beingo More productive lives

American Academy of Pediatrics. Medical Home Initiative for Children With Special Needs Project Advisory Committee, The Medical Home. Pediatrics Vol 110 No. 1 July 1 2002

Access - Medicaid and CHIP Medicaid and CHIP enrollment is open year-round!

In most states these programs cover children in families with income up to 200% poverty level.

American Academy of Pediatrics Committee on Child Health Financing. Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations. Pediatrics vol.133 no.3 March

2014

Access - Medicaid and CHIPWe have made great strides in children’s health insurance coverage since 1990s.

Since the introduction of CHIP, the rate of uninsured children in the US has declined significantly.

Health Insurance Coverage of Children 0-18

American Academy of Pediatrics Committee on Child Health Financing. Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations. Pediatrics vol.133 no.3

March 2014

Access - Medicaid and CHIPThe percentage and number of children covered by public health insurance (Medicaid and CHIP) has increased steadily since 1997.

American Academy of Pediatrics Committee on Child Health Financing. Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations. Pediatrics vol.133 no.3 March 2014

How can we FACE Poverty by focusing on Access?@ the clinic level - provide information about CHIP and medicaid for parents.

@ the community level - organize booth at back to school orientation and encourage parents to sign kids up for health insurance!

@ the legislative level - contact your representative as ask them to support policies that increase healthcare access.Advocate for reauthorization of CHIP and encourage states to take CHIPRA option to allow legal immigrants CHIP without waiting 5 years

-Write an op-ed or letter to the editor about how important access to healthcare and CHIP is to children.

Community &

Cycle of Poverty

Low or no income

Low wage jobs or

unemployment

Lack of food, security,

health, access

Poor cognitive, physical and psychological development

Little self-worth,

hopelessness, deficit

perspective

School drop outs to help

with $$

Little or no education

Cycle of Poverty = Persistence in Poverty Research:

o Between 1996-2006, most Americans in bottom 20% never moved up the income ladder.

o 20% of U.S. children <18 yrs live in poverty and likely to remain in poverty as adults.

What fosters intergenerational cycles of poverty?o Direct: living in poverty means lack of resources = inability to mobilize out of poverty.

o Indirect: Effects on child development result in harmed child resilience, poor cognitive development = helplessness, hopeless, little self-worth.

Proximal and Distal Influences in the Community: Contributions to poor EBCD = Cycle of Poverty

How can we FACE Poverty by focusing on the Community? Ecological Perspective of

Poverty

Community: FACE Poverty Initiatives @ the Family level Advocate for increase paid parental leave Promote positive parenting method when giving anticipatory guidance.

Promote early literacy programs like Reach out and Read

When communicating with families in clinic, use:o Strength-based care o Motivational Interviewingo Shared decision making

See resources below for other parenting strategies and clinic visit guidance that promote healthy child development.

Not only about going to school, also about effective schooling.

Promote after school activities for your patients.o Make a resources handout to give to families in clinico Promote Increased School Connectedness

Team up with schools in the community to promote positive schooling.o Eliminate ‘deficit perspectives,’ promote strength based

teaching

Community:FACE Poverty Initiatives @ the School level

Neighborhood interventions should come from those in the community.

Collaborate with community to: o Build safe places for playo Improve neighborhood aesthetics o Increase individual action to steer life path

Community-driven development Access to places for physical activity, to supermarkets, to healthy food

Community:FACE Poverty Initiatives @ the Neighborhood level

#1 Early Childhood Education (Birth – Pre-formal schooling)

o The brain TRIPLES in size between birth and 2 years of age – this a CRITICAL time. Home visiting programs and quality child care are crucial

o Percent of 3-5 year olds enrolled in full-day prekindergarten increased from 21% in 1994 to 28% in 2012.

o 28% of America’s 4 yr olds enrolled in state-funded educational program in 2012-2013,unchanged from year prior.

o First time seen a decrease in # enrolled = actual number of children enrolled in 2012-2013 decreased (9,000 fewer 4 yr olds, 42 less 3 yr olds).

Education

Author

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E

#2: High School Dropout: the Numbers and Prevention StrategiesThe Numbers:1. Over 1.2 million students drop out of high school in the United

States every year = 1 student every 26 seconds – or 7,000 a day.

2. A high school dropout will earn $200,000 less than a high school graduate over his lifetime and almost a million dollars less than a college graduate.

3. Almost 2,000 high schools across the U.S. graduate less than 60% of their students.

Prevention: @ the Clinic level:

o Promote afterschool activities, free tutoring services, resources handout

o Talk with teenagers about income gap (high school/college graduates vs dropouts)

o Ask about future/life goalso Motivate, empower to reach for the stars

@ the Communityo School and community collaborations o Professional development

#2: High School Dropout: the Numbers and Prevention Strategies

Racial Disparities in Dropout Rates

▪ There are higher rates of school dropouts among black and Hispanic youth as compared to white youth.

▪ There is also a significantly higher drop out rate among youth that are foreign born and those whose parents are foreign born compared to children with native born parents

Clinic and Community

Compile a list of resources in your community that help lift families out of poverty to share with patients and other providers.

Distribute IHELLP badge cards to providers and educate others on obtaining social histories.

Wear your FACE Poverty badge holders and T-Shirts and help spread awareness.

Federal/State Advocacy

Read the Academy’s federal policy positions. Contact your state and federal legislators -> Support policies that help lift families out of poverty.

All members of SOMSRFT are now automatically signed up to be a key contact and receive emails.

Organize or participate in a FACE poverty advocacy day at the state capitol.

Write an op-ed or letter to the editor.

Get Involved!

Organize a project at your school/program, in your community, state, or AAP district.

Read our FACE Poverty newsletters. Give THIS lecture! Join the SOMSRFT advocacy subcommittee. Advocate through social media

o Check out SOMSRFT social media toolkit #FACEPoverty Visit our website: http

://www2.aap.org/sections/ypn/r/advocacy/FACEPoverty.html

AcknowledgmentsSpecial Thanks to:

Julie Raymond, CAEBarbara MillerJamie PosloskySteven Federico, MD, FAAPBenard Dreyer, MD, FAAPAAP Department Federal AffairsAAP Division of State Government

AffairsAAP Poverty Workgroup

SOMSRFT Advocacy Subcommittee:Danna Qunibi, MD Lauren Gambill, MDJennifer Kusma Kym Gonzalez, MD Elizabeth Van Dyne, MD Jen Wolford, DO, FAAP Avika Dixit, MD Natasha Sriraman, MD, FAAP Philip Zachariah, MD Rebekah Kim, MD Michael StrattonJohn Carey, MD Courtney Smith, MD Catherine Urban, MD Irina Prelipcean, MD Nan Du Chirag Parikh

Erin Kelly, MD Christian Pulcini, MD, MEd, MPH Kristin Schwarz, MD Puja Umaretiya Alison Mols Heather Abraham, MD Lisa Costello, MD Rathi Asaithambi, MD, MPH Sameer Vohra, MD Justin Schreiber, DO Kathleen Rooney, MDShana Godfred-Cato, DO Angela Sandell, MD Anita Shah, DO Michael Epstein, MD Shae Anderson, MD Athra Kaviani, MD

Acknowledgments: AAP Poverty Workgroup

Andrew Racine, MD, PhD, FAAP (Chair) Carole Allen, MD, FAAP Steve Federico, MD, FAAP Andrew Garner, MD, PhD, FAAP Benjamin Gitterman, MD, FAAP Renée Jenkins, MD, FAAP Katie Plax, MD, FAAP Barbara Ricks, MD, FAAP Sarah Jane Schwarzenberg, MD, FAAP Elizabeth Van Dyne, MD, FAAP Benard Dreyer, MD, FAAP

Thank you!