FACE POVERTY 2015-2016
Section on Medical Students, Residents, & Fellowship Trainees
Tri Chairs: Alexandra James, Gabriella Polyak, Geneveive Guyol
SOMSRFT Annual Advocacy Campaign
Provides a framework for YOU to get
involved, learn about advocacy, and
implement an advocacy project of your
own.
Past SOMSRFT Advocacy Campaigns
2014/2015: FACE Poverty
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 Extend FACE Campaign?
Impact of poverty on child health is complex
We are excited to build on the momentum of the
campaign to empower pediatricians-in-training to think
boldly about partnering with communities and execute
projects that address the ways in which poverty affects
the health of their patients.
Today’s Presentation Will Cover:
 Impact
 FACE
of Poverty on Child Health
Campaign Issues
 Pillars
of 2015-2016 Campaign
Why Focus on Poverty?
Poverty is a Medical issue and a significant
determinant of child health
 Poor
quality healthcare = Worse health outcomes
 Higher incidents of:
 Infant
mortality
 Developmental delays
 Asthma
 Ear infections
 Obesity
 Poor nutrition
 Child abuse and neglect
 Adversely
impacts health into adulthood
What exactly is poverty?
$24,250 annual income for a family of 4
 Does
not vary based on geographic differences or cost
of living
 Outdated: the
manner in which “poverty” is calculated
is based on 1969 data
 Does
not account for many of the expenses (nor the
benefits) many families incur/receive
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.
Racial Disparities in Poverty
Suburban Poverty
Most pediatricians will care for
low‐income/poor families.
 Economic insecurity impacts a
diverse child population
 Since 2008, suburbs have
experienced the largest and
fastest increase of poor
populations
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
disease
inflammatory markers: leading to adult CV
FACE Poverty
Food security/nutrition
Access
Community
Education
Food Security, Nutrition and Obesity

14.3% of US households in 2013 were
food insecure (unable to obtain
adequate food). Among households
with children it was 20%

45% of low income families are food
insecure

What is “adequate food?”

HFSS or the “Hunger Vital Signs” can
assess Food insecurity
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)
How Do You FACE Food Insecurity?
Locally:



At the clinic: Check the Hunger Vital Signs
Encourage patients to sign up for WIC and SNAP
Provide information about local food banks
State:
Encourage summer lunch programs
 Connect with your AAP chapter and work on state/local
initiatives to decrease food insecurity
Nationally:
 Lobby and promote the Healthy School Lunch bill
 Advocate for continued SNAP funding and enhanced
SNAP benefits for immigrant families

Access
Increasing access to patient centered medical
homes alleviates 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:



Improved health
Improved well-being
More productive lives
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.
Access - Medicaid and CHIP
We 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
How Can We FACE Poverty by
Focusing on Access?
 Clinic
- provide information about CHIP and medicaid for
parents
 Community - organize booth at back to school orientation
and encourage parents to sign kids up for health insurance!
 State - work with chapters to encourage states to take
CHIPRA option to allow legal immigrants Medicaid/CHIP
coverage without waiting 5 years
 Federal - contact your federal representative as ask them
to support policies that increase healthcare access
-Write an op-ed or letter to the editor about how important access to
healthcare is for children!
Low or no
income
Low wage jobs
or
unemployment
Little or no
education
School drop
outs to help
with $$
Community
&
Cycle of
Poverty
Little self-worth,
hopelessness,
deficit
perspective
Poor cognitive,
physical and
psychological
development
Lack of food,
security, health,
access
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
Community: FACE Poverty Initiatives

Family: Promote positive parenting method when giving
anticipatory guidance

School: Promote after school activities for your patients
o Make a resources handout to give to families in clinic
o Promote Increased School Connectedness
o Team up with schools in the community to promote
positive schooling

Community: Community-driven development
o Access to places for physical activity, to supermarkets,
to healthy food
Education
#1 Early Childhood Education (Birth – Pre-formal schooling)





Brain triples in size from birth – 2 yrs = 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 ever 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:


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
Community level:
o School and community collaborations
o Professional development
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 help spread awareness
State Advocacy
 Connect
with your state AAP chapter
 Check
out the StateView blog (www.aap.org/stateview)
to keep up to date with trending state policy
information
 Contact
the AAP Division of State Government Affairs at
stgov@aap.org for more information on state level
poverty policies and related information
 AAP
Advocacy Guidehttp://www2.aap.org/commpeds/CPTI/trainingmodules.cfm
Federal Advocacy
 Read
the Academy’s federal policy positions
 Contact
your federal legislators and support
policies that help lift families out of poverty
 All
members of SOMSRFT are automatically signed
up as a key contact and to receive emails
 Write
an op-ed or letter to the editor
Pillars of 2015-2016 Campaign
 Celebrating
Ideas
Accomplishments and Inspiring New
 National Advocacy Map
 Newsletter Advocate Features
 Trainee
Education
 QI Toolkit: using
projects
 Mentorship
 Building
QI to evaluate and improve advocacy
a National Movement
 Social Media
 Unified Action
Focus for 2nd Year of FACE Poverty
 Revolves



around 3 pillars:
Recognizing accomplishments of trainees facing poverty around the
country
Education of trainees on advocacy and childhood poverty
Call to action to have all trainees across the country fight childhood
poverty in their communities
Recognize the
Accomplishments
• How do YOU Face
Poverty
• Google Interactive
Map
• National Project
Awards
• Articles in
newsletters
Call to Action
• National Advocacy
Day
• New Resident
Projects
• Social Media Storm
Residency Advocacy
Education
• QI toolkit
• Website/Resources
• Newsletters
• FACE Poverty PPT
Education of Trainee
 QI TOOLKIT
 By us for us
 Descriptor of advocacy
 Advocacy translation into
 How
to find your passion and turn it into a project
 Resources

QI
and Grants
http://www2.aap.org/sections/ypn/r/advocacy/QIToolkit.pptx
 Letter
to program director
 http://www2.aap.org/sections/ypn/r/advocacy/ElectDel
egates.pdf
 SOMSRFT
listserv
Advocacy Subcommittee Newsletter and
Celebrating Accomplishments &
Inspiring New Ideas
 Use
Google form to submit projects at your
program or in your community that affect poverty
and child health
 Use
the map to connect with people across the
country who have similar advocacy interests
 Submit
suggestions for advocacy newsletter
features
National Call to Action
 National
Call to Action for all pediatric training
programs to unite and demonstrate a commitment to
fighting poverty in their communities
 Spring
2016 in association with Red Nose Day
 All
program directors have received a letter outlining
its objective
 Way
to promote poverty education and unite us all in
making a difference to those children living in
poverty in our communities
National Call to Action
Each training program will be asked to participate in
addressing ONE of the four letters in FACE poverty

Food Insecurity - work with local food banks, host a food drive
or set up buddy pack programs in conjunction with USDA
 Access - host a community event to sign children up with CHIP,
if eligible, or help them find other means of insurance
 Community - work with Habitat for Humanity to provide for
family housing needs or build a playground to provide healthy
play for children
 Education - work in conjunction with local libraries and clinics
to promote literacy through programs such as Reach out and
Read
Social Media
 Facebook:
 American
Academy of Pediatrics or SOMSRFT
 “like” the page
 “like” statuses and updates and “share” on your own
page to lets friends know what you support and what
is going on around you
 Post comments onto these pages
 Twitter
 “Tweetiatricians”

Attend events and use twitter as way to address
controversies, accomplishments, etc.
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
 Check
out SOMSRFT social media toolkit
#FACEPoverty
 Visit
our website:
http://www2.aap.org/sections/ypn/r/advocacy/FACEPoverty.html
Thank you!