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, Succeed
2011/2012: Vote for Kids
2010/2011: Childhood Obesity
2009/2010: ImmuneWise
2008/2009: 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-StrategicPlan-Poverty-Child-Health.aspx
What exactly is poverty?
$23,850/year for a family of 4
 Does
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 Outdated: the manner in which “poverty” is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:
22% of children <18 lived in poverty
o
o
(16 million children)
45% of children <18 lived in
low‐income households
o
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-PovertyChild-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-StrategicPlan-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:
A:
C:
E:
Food security/nutrition
Access
Community
Education
Food
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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.”
Food



Security, Nutrition and Obesity
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
How do you FACE food insecurity?
Locally:
o At the clinic: Check the Hunger Vital Signs
o Encourage patients to sign up for WIC and SNAP
o Provide information about local food banks
State:
o Encourage summer lunch programs
Nationally:
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 health
o Improved well-being
o 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 CHIP
We have made great
strides in
children’s health
insurance coverage
since 1990s.
Health Insurance Coverage of Children 0-18
Since the
introduction of
CHIP, the rate of
uninsured children
in the US has
declined
significantly.
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 CHIP
The 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.
Low or no
income
Little or no
education
Low wage jobs or
unemployment
Lack of food,
security, health,
access
School drop outs
to help with $$
Little self-worth,
hopelessness,
deficit
perspective
Poor cognitive,
physical and
psychological
development
Community
&
Cycle of
Poverty
Cycle of Poverty = Persistence in
Poverty

Research:
o
o

Between 1996-2006, most Americans in bottom 20% never moved
up the income ladder.
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
o
Direct: living in poverty means lack of resources = inability
to mobilize out of poverty.
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
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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
o
o

Strength-based care
Motivational Interviewing
Shared decision making
See resources below for other parenting strategies
and clinic visit guidance that promote healthy child
development.
Community:
FACE Poverty Initiatives @ the School level
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Not only about going to school, also about effective
schooling.
Promote after school activities for your patients.
o
o

Make a resources handout to give to families in clinic
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 Neighborhood level
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Neighborhood interventions should come from those in
the community.
Collaborate with community to:
o
o
o
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Build safe places for play
Improve neighborhood aesthetics
Increase individual action to steer life path
Community-driven development
Access to places for physical activity, to
supermarkets, to healthy food
Education
#1 Early Childhood Education (Birth – Pre-formal
schooling)
o
o
o
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
Percent of 3-5 year olds enrolled in full-day prekindergarten
increased from 21% in 1994 to 28% in 2012.
28% of America’s 4 yr olds enrolled
in state-funded educational program
in 2012-2013,unchanged from year prior.
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).
E
#2: High School Dropout: the Numbers
and Prevention Strategies
The 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.
#2: High School Dropout: the
Numbers and Prevention Strategies
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 goals
o Motivate, empower to reach for the stars
@ the Community
o School and community collaborations
o Professional development
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
rate among youth that are foreign born
and those whose parents are foreign born
compared to children with native born
parents
out
Clinic and Community
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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
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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
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o
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Check out SOMSRFT social media toolkit #FACEPoverty
Visit our website:
http://www2.aap.org/sections/ypn/r/advocacy/FACEPoverty.html
Acknowledgments
Special Thanks to:
SOMSRFT Advocacy Subcommittee:
Danna Qunibi, MD
Lauren Gambill, MD
Jennifer 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 Stratton
John 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, MD
Shana Godfred-Cato, DO
Angela Sandell, MD
Anita Shah, DO
Michael Epstein, MD
Shae Anderson, MD
Athra Kaviani, MD
Julie Raymond, CAE
Barbara Miller
Jamie Poslosky
Steven Federico, MD, FAAP
Benard Dreyer, MD, FAAP
AAP Department Federal Affairs
AAP Division of State Government Affairs
AAP Poverty Workgroup
Acknowledgments:
AAP Poverty Workgroup
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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!