Community Pediatrics

This rotation fulfills the Pediatric RRC requirement for a block-long experience in community pediatrics. Your point of contact for the rotation is Dr. Cassandra Carr. Her office number is 301-295-4938, her beeper number is 1-800-759-8888/ Pin # 1251823, and her email is .

The rotation is designed for you to see and experience organizations, programs, and services – both military and civilian – that you may not see in other rotations during your pediatric residency. It is your opportunity to learn about services that will assist you in your career as a pediatrician, to complement the didactic and patient-centered learning that you receive in the hospital. By learning about available services in your military and civilian community, you are able to better care for your patients and families.

The rotation requirements are listed below under “Goals and Objectives”. To pass and complete the rotation, you must fulfill the requirements of 20 site visits with written evaluations, a morning report presentation, a contribution to the residency’s community pediatrics project, and submission of a completed written examination. Your rotation evaluation will be completed by Dr. Carr after all rotation requirements have been fulfilled. Aside from the requirements, it is up to you learn and experience as much or as little as you like during the rotation.

GOALS AND OBJECTIVES

Overall goal:To prepare residents to act as advocates for children and adolescents, collaborating with others in the community to optimize the health and well-being of children and adolescents in their community

Participants:PL1, PL2, and PL3 residents

Duration:3 years, activities to be planned by resident on post-call days

Design:The rotation is designed to fulfill four of the six pediatric general competencies.

Through their exposure to diverse populations in the military medical system and community resources visited during the rotation, the resident demonstrates adherence to the ethical principles of the discipline of medicine and the respect of ethnic, cultural, religious, age, and sexual diversity. By visiting multiple military and community resources, the resident will improve care of their own patients. Through exposure to various medical and community resources dedicated to public health, environmental health, and child abuse the resident gains medical knowledge in those areas, enhancing patient care. By gaining knowledge about services available in their own medical system and in the surrounding community, the resident demonstrates competent systems-based practice.

RRC Requirements

JAN2006: Structured educational experiences with planned didactic and experiential opportunities for learning and evaluation

 Preparation of residents for role of child health advocate within the community

 Curriculum including

community-oriented care with focus on the health care needs of all children within a community, particularly underserved populations

culturally-effective health care

effects of common environmental toxins and potential bioterrorism agents on child health

role of pediatrician as consultant to schools, early childhood education, child care settings

role of pediatrician in child advocacy and legislative process

role of pediatrician in disease and injury prevention

role of pediatrician in regional emergency medical system for children and handling of mass casualties

 Experiences take place in settings in the community

 primary care practices

 community health resources and organizations

 governmental and volunteer agencies

 Examples include public health departments, services for children with disabilities and special healthcare needs, Head Start, schools, home health services, hospice, facilities for incarcerated youth, facilities for management and treatment of substance abuse

Facilities utilized:NNMC Bethesda, WRAMC, various military and civilian day cares, schools,

clinics, institutions, and hospitals in the DC metro area; public facilities which house support groups and services for youths and families; and federal, state, and local agencies and organizations that provide assistance and education to children, adolescents, and their families

Teaching Faculty:Varies by location of site visit, to include physicians, nurses, social workers,

teachers, therapists, community advocates, parents

Requirements:a. 20 individual site visits

1. One site must be 5 visits to the Armed Forces Center for Child Protection

2. One visit must be a half- or full-day experience at a local

transitional/rehabilitation/chronic care facility, the Hospital for

Sick Children or the Children’s National Rehab (at National Rehab

Hospital)

  1. Three visits must be home visits

continuity patient from resident’s continuity clinic

NICU high-risk follow-up

WARD/PICU follow-up, patient that requires case management

-- One of the above patients must be significantly ethnically or culturally different from the resident

  1. One visit must be to the Tricare (military healthcare) office or a

search through the Tricare website (

  1. One visit must be reviewing cases on the USUHS Environmental Health CD (Dr. Carr has a copy of the CD for use during this rotation)
  2. One visit must be with an Early Intervention or Child Find specialist to observe intake of a new patient
  1. Participation in the resident’s community pediatrics project, Military Partners in Parenting Education. See the description below for further information about this requirement.
  2. Participation in long term service project involving provision of medical, health, safety information to inner city underserved population of children, two-three visits in three years
  3. One 15 minute presentation in morning report on a community pediatrics experience that was educational for the resident and would be beneficial and educational for other pediatric residents and staff
  4. Didactic reading
  1. AAP Community Pediatric Website – found on the AAP’s

website

  1. AAP Policy Statement on the Pediatrician’s Role in Community

Pediatrics – found on the AAP’s web site

  1. The International Resilience Project
  2. Developmental, Cognitive, and Behavioral Sequelae of Child Abuse
  3. Twenty Years Later: Do We Know How to Prevent Child Abuse and Neglect
  4. Medical Evaluation of Abused and Neglected Children
  5. Putting Children First: The Pediatrician as Advocate
  6. Commentary: Training Pediatricians to Become Child Advocates
  1. Quarterly update with advisor to ensure appropriate progress through all three years
  2. Complete and submit site evaluation forms for all 20required site visits, with useful feedback information for future rotating residents
  3. Complete and submit written examination (found at the end of this packet)

Competency-Based Learning Objectives:

A. Professionalism – The resident will carry out daily clinic duties in a profession manner,

will fulfill all responsibilities, and will adhere to accepted ethical principles.

The resident will demonstrate sensitivity to ethnic, cultural, age, sexual, and religious diversity.

  1. Demonstrates appropriate military bearing; well groomed in the uniform of the day; behaves in a manner appropriate for a military officer
  2. While doing site visits both in the hospital and in the community at large, respects patient privacy by not discussing patient care issues in public; knows HIPAA regulations and follows HIPAA instruction with respect to transfer of medical information by fax, e-mail, etc.
  3. Show respect for patients’ and families’ cultural, religious, sexual, and ethnic background; understand that their beliefs regarding medical care may be different from the medical community; design a plan of care for the patient that integrates both the families’ beliefs and the recommendations of the medical community
  4. Describe special health and social issues for the diverse population of patients encountered during this rotation (families with deployed spouses, single active duty mothers, ethnic minorities), and identify barriers that prevent their access to optimal health care
B. Medical Knowledge – The resident will demonstrate appropriate medical knowledge with respect

to environmental and community-related health issues and child abuse, and will apply this knowledge in the care of their continuity patients as well as patients cared for in the inpatient setting.

  1. Describe the medical and psychosocial workup of suspected victims of child abuse and

neglect. List which military, civilian, and law enforcement officials need to be notified and why

  1. Demonstrate knowledge of common clinical findings associated with child physical and sexual abuse and child neglect
  2. Explain potential causes of the increased incidence of child abuse and neglect in the military

population compared with the general population.

  1. Describe the role of the PoisonControlCenter, and the database from which the PoisonControlCenter obtains its information
  2. Explain the health risks to children of common environmental exposures (lead, cigarette smoke, pesticides, asbestos) as well as preventive methods to combat these exposures
  3. List at least five major public health issues affecting children over the last decade, and describe efforts designed to combat the negative outcomes associated with these public health issues
C. Systems-Based Practice – The resident must practice quality health care and act as advocates for

patients and their families in the health care system as well as in the

community at large.

  1. Explain why children need advocates, and why a pediatrician should function as a child

advocate

  1. Define some ways in which a pediatrician can function as a child advocate
  2. Describe the role of a pediatrician in health, environmental, and educational legislation, and

the role of the AAP in the legislative process

  1. Describe three different roles a pediatrician can function as a child advocate in a child care or

school setting

  1. Demonstrate knowledge of services available in the military health care system as well as the

community for patients and their families needing:

  1. WIC assistance
  2. Environmental testing for household lead
  3. Formal school and medical evaluations for neurodevelopmental disabilities (ADHD, autism, learning disability)
  4. Physical, occupation, speech, or feeding therapy
  5. Financial assistance for personal/family crises
  6. Chronic care/pediatric rehabilitation/respite care services
  7. Exposure to domestic violence
  8. Support for coping with children with special health care needs
  9. Modifications in a child’s Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP)
  10. Special medical equipment
D. Patient Care – The resident will provide compassionate, family-centered medical care that is effective in meeting the child’s health care needs and promotes overall health.
1.List military and community resources/organizations visited that will improve the medical care and promote the overall well-being of the following groups of children:
a.Children of single active duty parents
b.School-age children with neurodevelopmental disabilities
c.Premature infants with global developmental delay
d.Children at risk of abuse, neglect, or exposure to domestic violence

e. Children with chronic medical conditions/special health care needs

  1. Demonstrate awareness of public health issues by counseling families on seat belt use, lead

exposure, firearm safety, proper sleep positioning, and exposure to cigarette smoke

MORNING REPORT PRESENTATION

One of the requirements of the rotation is a 15-20 minute morning report presentation highlighting one of your community experiences. The presentation may be given at either NNMC or WRAMC, and preferably during the block you are actually doing the rotation. The goal of this presentation is to share with your colleagues information about a military or community service that you think would be valuable in the current or future care of your pediatric patients. It should include:

  • The purpose of the program/agency/service you visited
  • The population it servesand its accessibility to that population
  • How it is funded (federal, state, local, private, etc.)
  • How it serves or could serve the military pediatric population
  • Why this program is interesting to you

NCC COMMUNITY PEDIATRICS PROJECT

In the Spring of 2004, the NCC Pediatric Residency Program started a program called Military Partners in Parenting Education, founded by Dr. Kelli Nayak and Dr. Chris Watson. The project is funded by an AAP CATCH (Community Access to Child Health) grant for the initial 6 months of the project. The goal of the project is to partner with other military medical “homes” – the ChildDevelopmentCenters and the Youth Services After School Programs in the Washington, DC metro area – to provide pediatric health education to military families and to providers at these centers. This education will take place in the form of lectures that will be given at the CDC or the Youth Services Program. In the initial stages of the project, a series of four lectures is planned at each site, with a light dinner provided to families during/following the lecture.

Your role during your community pediatrics rotation will be to contribute to the project in one or more of several different ways, including but not limited to:

  • Preparing a lecture to be given (the topics will be decided in advance)
  • Going to one of the sites to give a lecture with another resident(s)
  • Assisting with advertising for the project
  • Coordinating upcoming lectures/dinners with each site
  • Soliciting potential sites for future lectures
  • Investigating funding sources so that the project may continue
  • Possible grant/budget writing to apply for further funding for the project
  • Collecting and interpreting data relating to the effectiveness of the program

When you meet with Dr. Carr at the beginning of your rotation she will discuss with you in what stage the project is, and what options will be available for you to work on. Participation in the project is a requirement of the Community Pediatrics rotation.

For those who are interested in making SIGNIFICANT contributions to the project (procuring funding, data collection/interpretation/write-up), consideration will be made for this project to count as your residency research requirement.

SITE VISITS

  1. WOMEN, INFANTS, AND CHILDREN (WIC):

Where:11141 Georgia Avenue, Suite 116, Wheaton, MD

(Metro – Red line to Wheaton, behind the Metro Station)

ArlingtonCountyWIC

3033 Wilson Blvd., Arlington, VA22201

Note: You may any WIC office, if there is one closer to you

Search the WIC website () for other

locations and useful information

Point of Contact:301-762-9246 (General Staff, GA Ave.) – sometimes difficult to get someone on the phone

(703)228-1166 (Arlington)

Goals:To learn about the eligibility requirements for enrolling in WIC;

what information is required for new enrollees; the benefits of

WIC participation; which military families are eligible; what

educational programs are available through WIC

2. ARMED FORCESCENTER FOR CHILD PROTECTION:

Where:AFCCP is located in building 1 (the Tower), on the 10th floor

Point of Contact:Dr. Barbara Craig (295-5648);

Please note this is a 5 half-day experience

Goals:To learn and understand how to do a basic evaluation for child

physical and sexual abuse, as well as child neglect; to participate

in the evaluation of children referred to AFCCP for alleged abuse;

to learn basic information about the colposcope and its use in

child sexual abuse evaluations; to work on Dr. Boos’ Child Abuse

Evaluation CD; to read the required articles

3. PARENT SUPPORT GROUP MEETINGS:

It is best to search the internet if you are interested in attending any parent support

group meetings. Groups such as CHADD (Children with Attention Deficit

Disorder), Autism Society, Learning Disability Association, have monthly

meetings in various locations. Previous residents have had success searching for

support groups in MontgomeryCounty and in AnneArundelCounty

Where:Various locations

Point of Contact:as above, search the internet for this information

Goals:To experience a child’s chronic medical or behavioral problem

from the side of the patient and family; to learn about the

medical “information” that is shared at these meetings

4. NAVY NEW PARENT SUPPORT TEAM:

The New Parent Support Team is a professional team consisting of community

health nurses and social service assistants. The provide education and support

services to expectant Navy families and those with young children, especially

single active duty mothers and families who have been identified by a provider as

being in need of services. The team attempts to assist new parents, through home visits in the first year of the child’s life, in coping with the demands of parenthood and military life, and to increase their parenting skills.

Where:NNMC Building 1(Tower), 2nd floor room

Point of Contact:New Parent Support Team office, 295-2674/5647

Goals:Gain exposure to this program and what it provides to Navy

families; accompany one of the staff on a home visit

5. AMERICANACADEMY OF PEDIATRICS

If you have not been on the AAP website, this rotation would be a very good

opportunity to browse the website () and all that it has to offer for both physician and parent education. The AAP sponsors Advocacy Days where you can meet with your congressman/representative to discuss issues relating to pediatrics, or work with others to advocate on Capitol Hill on behalf of children.

Where: AAP Office, 601 13th St., Suite 400, Washington, DC

(Red Line to MetroCenter, go out 13th Street exit and turn left)

Point of Contact:Ms. Mary McGowan, 202-347-8600, 800-336-5475

Goals:Increasing your knowledge about the pediatrician as advocate;

acquiring basic information relating to advocating at a national

level

6. POISONCONTROLCENTER

Where:3201 New Mexico Avenue, SuttonPlaceBuildingSuite 301.

From NNMC, go south on Wisconsin Ave. and take a right on

Nebraska Avenue (just past AU/Tenleytown Metro). Follow past

Channel 4 HQ and Naval DistrictWashington, then go around

Circle at Massachusetts Avenue but stay on Nebraska. After circle

turn left at first light onto New Mexico Avenue, and go 1000

Yards to brick building on the left. You can also take the Metro to

the Tenleytown stop and follow driving directions as above.

Point of Contact:Dr. Kathleen Clancy or Dr. Toby Litovitz 202-362-3867

Goals:Spend the day becoming acquainted with the Center and

POISONDEX; how calls are answered and followed up; what

Information they could provide to you as a provider if you were