A Framework for Pursuing Child Health Equity in Pediatric Practice.

This article brings together several disparate frameworks to help outline a needed shift in pediatric practice to ensure child health equity. That shift involves moving from a commitment to equal care delivery to an explicit commitment to equitable health outcomes. The frameworks describe (1) the distinct domains of child health where inequity can be expressed, (2) the shortfalls of equal care delivery in meeting that promise, (3) a coherent typology of the barriers that drive health inequity and (4) a characterization of interventions as downstream, midstream, and upstream in nature.

Partnering with Families and Communities to Improve Child Health and Health Equity.

Pediatricians and other pediatric health providers collaborate with families and communities, including schools, health departments, and other partners to advance pediatric health challenges and health equity. This article will discuss best practices and guiding principles to support engagement and effective partnership with families and communities. Models for engaging families and communities while promoting health equity will also be discussed. Case studies and examples will be shared, as well as how they may be applied by pediatric health providers to promote child health.

Urban Health Project: A Sustainable and Successful Community Internship Program for Medical Students.

BACKGROUND: Urban Health Project (UHP) is a mission and vision-driven summer internship at the University of Cincinnati College of Medicine that places first-year medical students at local community agencies that work with underserved populations. At the completion of their internship, students write Final Intern Reflections (FIRs). METHODS: Final Intern Reflections written from 1987 to 2012 were read and coded to both predetermined categories derived from the UHP mission and vision statements and new categories created from the data themselves. RESULTS: Comments relating to UHP's mission and vision were found in 47% and 36% of FIRs, respectively. Positive experiences outweighed negative by a factor of eight. Interns reported the following benefits: educational (53%), valuable (25%), rewarding (25%), new (10%), unique (6%), and life-changing (5%). CONCLUSIONS: Urban Health Project is successful in providing medical students with enriching experiences with underserved populations that have the potential to change their understanding of vulnerable populations.

Understanding the experiences of youth living with sickle cell disease: a photovoice pilot.

A Photovoice pilot was conducted with youth living with sickle cell disease (SCD), in order to further understand their lived experience and examine the acceptability, feasibility, and utility of this method in this population. SCD is an inherited genetic condition whose primary symptom is severe pain. Youth were able to reflect on their experiences with SCD using Photovoice and the adapted SHOWeD method. Parents and youth found Photovoice to be valuable for children and adolescents with SCD. Emerging themes included the impact of SCD, the importance of everyday activities and interests, and the importance of family and support.

¡Hazlo bien! A participatory needs assessment and recommendations for health promotion in growing Latino communities.

PURPOSE: To investigate the health needs of a rapidly growing Latino community and understand priorities for developing culturally sensitive health promotion strategies. APPROACH: A participatory research approach was selected to understand health challenges and opportunities for health engagement in the community. SETTING: Norwood, Ohio, a small community in southwest Ohio. PARTICIPANTS: Latino adults living, working, or accessing services in Norwood. METHOD: Trained community researchers collected survey data from 198 participants at multiple community "points of contact" and door-to-door in more isolated neighborhoods. Survey data were aggregated using descriptive statistics. Two focus groups were conducted with 25 community members, transcribed, and analyzed using principles of thematic analysis. Participants' health concerns, health behaviors, and access to/experiences with health care were assessed. RESULTS: Findings indicated significant health concerns, including overweight (43.2%) and obesity (28.6%), mental health challenges (anxiety 15.7%; depression 15.0%), and oral health concerns (23.0%). In addition, community members described barriers to accessing health care and strategies for preventing health problems and promoting positive health. Participants also discussed perceived discrimination and the need to address isolation within their community. CONCLUSION: Methods and findings from the ¡Hazlo Bien! participatory needs assessment are likely to be useful to those designing health promotion programs in quickly growing Latino communities where there are limited health services and few existing social support networks.

The community leaders institute: an innovative program to train community leaders in health research.

An emerging best practice of addressing health and improving health disparities in communities is ensuring that academic health centers (AHCs) are engaged with area schools, primary care practices, and community advocates as equal partners in research, services, and programs. The literature documents the importance of ensuring that academic-community collaboration is based on equity, trust, and respect and that there is capacity (time and resources) and a shared culture (language, skills, and applied knowledge) for accomplishing mutual goals in academic-community research partnerships. It is also essential that an academic-community collaboration result in tangible and measurable goals and outcomes for both the target community and the AHC. Currently, the models for implementing best practices in community health partnerships, especially training programs, are limited.This article summarizes the goals and outcomes for the Community Leaders Institute (CLI), a six-week innovative leadership development training program designed to enhance academic-community research, integrate the interests of community leaders and AHC researchers, and build research capacity and competencies within the community. On the basis of two years of outcome data, the CLI is achieving its intended goals of engaging faculty as trainer-scholars while promoting academic-community partnerships that align with community and AHC priorities. The training and collaborative research paradigm used by the CLI has served to accelerate AHC-community engagement and integration efforts, as CLI graduates are now serving on AHC steering, bioethics, and other committees.

Parent perspectives on pain management, coping, and family functioning in pediatric sickle cell disease.

Pediatric sickle cell disease is a chronic illness for which recurrent pain is a ubiquitous experience. This study used quantitative and qualitative methods to examine relationships between patient and family coping and health care utilization in children with sickle cell disease and to assess parents' recommendations for ensuring patient and family-centered care. Participants were 53 parents of children aged 7 to 13 with sickle cell disease across three large urban children's hospitals. Data showed that positive patient coping was related to positive family functioning and lower health utilization. In addition, parents report the need for comprehensive health care approaches that meet the physical and psychologic needs of patients and families.

Family functioning in school-age children with cystic fibrosis: an observational assessment of family interactions in the mealtime environment.

OBJECTIVE: To examine, using direct observation methodology, differences in family functioning at mealtime between families of school-age children with cystic fibrosis (CF) and families of school-age children without a chronic illness. METHOD: Family functioning was rated using the McMaster Mealtime Interaction Coding System (MICS) during a videotaped dinner among 28 families of children with CF and 27 families of non-ill, age-matched peers. Families were rated on overall family functioning and on six dimensions of the MICS: task accomplishment, communication, affect management, interpersonal involvement, behavior control, and role allocation. RESULTS: Ratings for families of a child with CF were significantly lower than they were for comparison families on overall family functioning and on four of the six MICS dimensions: communication, affect management, interpersonal involvement, and behavioral control. Moreover, a significantly greater percentage of families of children with CF were rated in the unhealthy range on overall family functioning and on five of six MICS dimensions. There was no relationship between family functioning and child weight status for children with CF. CONCLUSIONS: The current study suggests that for families of school-age children with CF, the family system is negatively affected during mealtime. Dietary interventions need to address family-centered, as well as child-centered, interventions to help families manage challenges presented during the family meal.