In the July Pediatrics in Review article, "Advocacy and Child Health Outcomes: Do Child Health Professionals Realize Their Opportunities?" I challenged readers to reflect on a variety of ways that pediatricians1 can engage in advocacy to improve patient outcomes (10.1542/pir.2023-006103). Today’s blog summarizes my personal advocacy experiences (1977–2023) integrating advocacy into the community.
Our rural North Carolina practice has partnered with organizations in efforts to improve patient outcomes. Team-building efforts to create a new pediatric presence in our low-income catchment area were exhausting, as we encountered multiple barriers to providing optimal health care for all children. Local coalition-based efforts resulted in system-based change by introducing the following:
- Level II Neonatal Unit
- Home visitation program to prevent child abuse and neglect2
- School-based health centers integrated with the practice
- School-based mental health program
- Practice-based mental health professionals
- Community-based early literacy program
- Career exploration opportunities for middle/high school students
- Practice-based Certified Lactation Consultants
Colleagues continue to rearrange their schedules to help me lead community-based advocacy initiatives, and community-based organizations often assume ownership of the projects.
I have assisted grant writers of community-based groups to procure funding for expansion of Head Start sites; hire a mental health coordinator, health educators, and nurse-social worker teams for the public schools; develop school-based health centers; and acquire funds for an early literacy program at the public library.
How can one pediatrician effect change outside the practice setting? Three key options come to mind:
- Attend meetings in the community
- Monitor local online, TV, and print news
- Develop or join community-based coalitions
Early on, I became concerned about the segregation of low-income minority children in our schools. By reading the local newspaper, attending meetings of concerned parents, and joining public school coalitions, I realized the value of child health professionals participating in community-based child advocacy. As an elected school board member, I helped bring all our public schools under one roof.
During the 1990s, the American Academy of Pediatrics (AAP) developed the CATCH (Community Access to Child Health) Program3. Through five CATCH projects, we have addressed such issues as child abuse and neglect, coordination of care for special needs children, Latino child health, children’s mental health, and Social Determinants/Drivers of Health.
We include community partners in our weekly virtual Category I Continuing Medical Education sessions, creating a forum within which to advance our multidisciplinary approach to improving child outcomes.
I would like to acknowledge the following persons in assisting me with the writing of this blog:
Judy Dolins, MPH
Francis Rushton, MD, FAAP
Steve Shore, MSW
Kathleen Clarke-Pearson, MD, FAAP
1The word “pediatricians” here represents any child health professionals.
2“In Search of the Pediatrician’s Role in Home Visitation, Parent-Child Centers, and Family Resource Centers in North Carolina” In Rushton, FE: Family Support in Community Pediatrics: Confronting the Challenge. Greenwood Publishing Co. (Praeger), Westport, CT, July 1998, pp. 103-110.
