ORGANIZATION: Crozer-Chester Medical Center is seeking a partnership with Widener University School of Human Service Professions/ Center for Education/ Child Development Center.
PROJECT PERIOD: July 1, 2000 to June 30, 2003
PROJECT FUNDING: Grant from the Department of Health and Human Services Health Resources and Services Administration
TOTAL PROGRAM BUDGET: $600,000, (3 year period)
GOAL:
The goal of the Pediatric Education to Deliver Community-Integrated Care to Children (PEDCIC) program is to develop an additional set of curriculum and community based learning experiences for pediatric residents in order to prepare them to deliver efficient and effective care in a medically under served area. Through the PEDCIC experience Pediatric Residents of Crozer- Chester Medical Center Pediatric Residency Program will come to understand the particular primary care and public health needs within the pediatric population of America's third poorest mid - size city, Chester, Pennsylvania. Through cooperation and collaboration with community-based social service and medical service providers, residents will learn to be advocates and community leaders in creating effective partnerships addressing specific pediatric health issues in a high-risk pediatric population. The program holds true promise in empowering pediatric residents-with knowledge and experience in "community-integrated services"- to pursue primary care careers in the content of underserved.
BACKGROUND INFORMATION:
Dr. Kathleen Reeves the Project Director of Crozer-Chester Medical Center contacted Noreen M. Nicholas, Director of Widener University Child Development Center, in May 2000. Dr. Reeves informed me about the PEDCIC Program and was seeking a partnership with Widener University Child Development Center and Center for Education. When asked why are you seeking a partnership, when Crozer-Chester traditionally trains their residents, Dr. Reeves responded that we are seeking Widener University support due to our positive rapport and relationship that we have with the Chester Community. The Child Development Center has been serving the children/families for twenty years. The Child Development Staff members have been providing workshops and training to community programs and are accepted in the Chester Community. The Center for Education has been training adults in early childhood education, elementary, secondary education and are seen as scholars in this area. Crozer-Chester is also seeking Widener University Faculty to design the residency program in the planning and development of the PEDCIC program, which will serve as a model of relationship building for the residents.
RATIONALE:
Children, particularly those raised in communities of socioeconomic hardship, are not only victims of infectious disease and traditional childhood illness. But also, in today's society, these children are much more likely to suffer from unintentional injury, impact of environmental risks and toxins, interpersonal violence, substance abuse, teen pregnancy, sexually transmitted diseases and HIV. "Future efforts to improve the health of children and adolescents must focus on community-level outcomes and include multidisciplinary models of care (Perrin, 1992).
Several studies have documented the lack of opportunities for residents to gain experience working with the medically underserved (Hill, 1996; Haq, 1996). Laurie (1997) states "A population-based approach to practice requires learning how to gather information about the community in which one works- about the demographics, the sociocultural beliefs and practices that affect the manifestation of health and disease, and the natural history and the major health problems in the population."
Because each underserved community (or any community) has its own particular set of needs and priorities, we believe that the process of adapting the residency program must follow the process of other successful community/collaborative programs: Community representatives must be involved from the beginning of the process. The relationships built by faculty of the residency program in the planning and the development of the PEDCIC Program will serve as models of relationship-building for the residents. This process empowers faculty as well as residents, as they face the challenges of providing care where there are so many barriers to access and seemingly intractable poor health status. We believe that the graduates of PEDCIC, and other similarly constructed residency programs, will not only be better prepared and more likely to practice in underserved areas. They will also be more likely to stay in those positions, empowered by the experience of communitycollaborative programming and less likely to "burn out" from the challenges and complexity of patient care in a vulnerable population.
OBJECTIVES:
Program-Specific Innovations and Objectives:
1. Design, develop and evaluate a Community Health didactic curriculum using input from key contact personnel from related community agencies from the target population.
2. Enhance the one-month block Community Medicine Rotation.
3. Augment the continuity clinic experience with utilization of the Community Care Plan process.
4. Provide Resident experience in a variety of innovative primary care settings.
5. To incorporate, in to the PEDCIC curricular, innovations teaching the residents the skills needed to be excellent educators within the communities.
6. Expand the education of pediatric residents about the acute and long term care of children victimized by abuse.
METHODOLOGIES:
To understand the innovation and ultimate impact of this program on the future practice decisions of residents you must understand the residents' experience as a dynamic threeyear process of information gathering and relationship-building. The residents will receive a didactic curriculum developed with input from a range of communitybased service providers. They will also listen to updates and presentations from these same individuals on a regular schedule. Finally, as they develop patientspecific "Community Care Plans" they will communicate with these same individuals in procuring the complementary services their patients frequently need to achieve meaningful health outcomes. It is only by immersion in the home, schools, the courts and relationships with individuals in those institutions that faculty and residents, alike, can meaningfully impact child health status in the community.
Through didactic experience in the daily scheduled noon conference we will introduce the residents to key contact personnel for each of the community service organizations primarily involved in the PEDCIC Program. The services that are available are:
Chester Upland School District
CUSD Medical Services
CUSD Attendance Program
CUSD Special Education and Special Education Advocacy Program
CUSD Nursing Services
Catholic Social Services
Community Legal Services
Ches Penn Health Services
Chester Healthy Start
Chester Police Department
City of Chester Department of Public Health
Pennsylvania State Department of Health
Delaware County Immunization Coalition
Delaware County Juvenile Court
Wellness Center
Pregnancy Prevention Program
Crozer School Violence Prevention Program
American Lung Association
CARAVAN (Trauma Prevention)
Regional Child Abuse Center
Children and Youth Servies
Social Work
Delaware County Sexual Abuse Center
Ches Penn Homeless Health Services
Cultural Sensitivity Training
Project Elect school program for teen parents
Women Against Rape
PROGRAM OBJECTIVES:
Objective 1: Have each of the key personnel from the community give an introductory didactic lecture to the residents at noon conference, reviewing the history and functions of his or her agency. From the process, develop a 3 year didactic curriculum with input from the key personnel for the residents at noon conference.
Objective 2: We also will augment the current community medicine rotation with the development of the Community Medicine Handbook. This handbook will be a collection of literature from the medical community and the service sciences used to enhance the resident's educational experiences on the community rotation. It will be a compilation of information provided by both teaching faculty and key community personnel.
Objective 3: The Community Care Plan process will be developed similarly to clinical care pathways. The process will have an easy way to evaluate if a patient is high risk, which services may be in need, how to access these services and how to document the initiation and continuation of the Community Care Plan process. The process will easily be adapted for universal use in screening all patients in a clinical setting. Both the physicians and the community personnel involved in caring for the patient will provide specific documentation that will be included in the chart under CCP section.
Objectives 4: Assure resident placement in the hospital clinic, large and solo practitioner practices, college health clinic and health care in the juvenile care center, school based clinic, Regional Abuse Center, community based developmental clinic.
Objective 5: The PEDCIC Program will provide a four part workshop on how to teach professionals, parents and patients, as well as, how to deliver useftil, educational didactic sessions. All the residents will complete this workshop over their 3 years.
Objective 6: We have teaching faculty who have acquired additional training in the care of abused children. Currently, with the support from the institution, emergency medicine facilities, the Social Work Department and Department of Psychiatry, Children and Youth Services and the Chester Police Department, we have developed a Regional Child Abuse Center, which has begun to provide complete services for these children. This center will serve as a site to train pediatric residents, family practice residents, OB-GYN residents, case workers, social workers and other professionals in mental health and law enforcement.
EVALUATION:
A range of quantitative and qualitative data will be collected to evaluate the impact of,and outcomes from, the initiatives in this project proposal.
1. The initial set of outcome measures will be to evaluate the impact of the program on the residents themselves. A series of pre- and post tests (forced choice, closed questions) will be given to residents as they move through each program experience. Each objective will have its own survey schedule, some testing close to the specific component and some designed to test changes in knowledge and attitude over the full three years of program development and implementation. These project-specific surveys will be designed and analyzed by the Program Evaluator. The Residents will also be reviewed through a series of traditional tools including direct observations and service diaries.
2. Each of the participating faculty will be asked to answer similar surveys concerning their attitudes toward, and knowledge of, the new paradigms and roles as put forth in the Pediatric Education to Deliver Community-Integrated Care. The expanded role of the residents, as primary are Pediatrician as patient advocate, patient/family educator, community activist, etc.
3. Each of the collaborating agencies will be surveyed annually to determined their satisfaction and qualitative response to service collaboration.
4. All patient contacts will be recorded in the Project Database to provide an aggregate process evaluation of services rendered to the community. This date will be accompanied for each community-based service by some measure of health status or health outcome. These and similar health service or access questions may be generated by the residents themselves, leading to more complex research questions and formalized inquiry.
5. The Project Director and the faculty will record "significant events" in program planning, development, implementation and evaluation in the Project Log Book. A final Program Documentation Report will be produced following year three. The Project Documentation Report will be posted each year and at the end of year three as a project dissemination function.
BENEFITS:
1. Widener University Center for Education has traditionally educated undergraduate and graduate students seeking a degree/ teaching certification in early childhood, elementary education and special education. This partnership would open additional avenues in educating future pediatricians in current issues and services in early childhood education.
2. This partnership would serve as an outreach program and support for the Chester Community (Children and Families).
3. This "Community-Integrated model" would strengthen our positive relationship with community services.
4. Our faculty would have the opportunity to be actively involved in the research component of this project.
5. Our faculty would be seen as experts in specific areas of early childhood and current issues in the field.
6. Participation in this project would lead to research, publications, presentations to the medical community, etc.
7. Faculty would receive overloads and or release time to participate in this partnership.
8. This relationship with Crozer-Chester could enhance future partnerships/avenues of educating the community, families, organizations in the field of human growth and development, early childhood, special education, elementary school issues, etc.
9. The residents would participate at the Child Development Center as a field placement setting. The Child Development Center staff members, parents and children and university students, would receive support from the residents in the area of health and safety issues through workshops/ presentations.
10. The residents field placement at the Widener University Child Development Center would give them an opportunity to participate in a high quality child care facility. The Child Development Center is a NAEYC Accredited program.
11. The faculty will have the opportunity to collaborate with community sites in development of the curriculum and implementation of the program.
12. Participating faculty members will provide a one-hour lecture at noon conference attended by all of the residents to review their organization role and how they service the families of our community. The faculty will serve as a contact person for the residents.
COST:
1. The program is completely funded by the Department of Health and Human Services, Health Resources and Services Administration. The program will be funded for three years from July, 2000 to June 30, 2003.
2. The total cost $600,000 (3 year period).
3. Crozer-Chester has committed to financially continue this program once the grant commitment has been completed. 4. Indirect Cost to the University - Release time from Widener University for faculty to participate in the partnership. Faculty will present from noon until one o'clock, which should not interfere with their teaching schedule at the University.
CONCLUSION:
Widener University partnership with Crozer-Chester would open additional avenues of training adults in early childhood and current issues in the field. Widener University participation in the PEDCIC Program would serve as an outreach and support to the Chester Community (residents, children, families and community). The communityintegrated model would strengthen our relationship with community services. The faculty would be seen as experts in the field of early childhood. Our faculty would have the opportunity to be activity involved in the research, publications and presentations to the medical community. Our faculty would receive overloads and/or release time to participate in this project.
This relationship with Crozer-Chester could lead to future partnership/avenues of educating the community, families, organizations in the field of human growth and development. The faculty will have the opportunity to collaborate with community programs in the development of the curriculum and implementation of the program. Participating faculty will develop and provide one-hour lectures at the noon conference which will be attended by all of the residents. The faculty will serve as a contact person for the residents. The Child Development Center will serve as a field placement opportunity for the residents in which they will have the opportunity to participate in a high quality child care program. The Child Development Center family will have the opportunity for the residents to share their expertise in the area of health and safety issues through workshops/presentations. The project is being completely funded by the Department of Health and Human Services for three years.
References
Haq Cl., Cleeland L., Gjerde Cl, Goedken J., Poi E., Fam Med 1996. Sep; 28 (80); 570
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Lurie N. Acad Med 1996. Oct; 71 (10):1044-1049.
Perrin J., Guyer B., Lawrence J., The Future of Children 1992 Winter 2 (2):58-77.