Projects

The AAP supports projects that address the provision of culturally effective pediatric care through its various programs, including CATCH, Healthy Tomorrows, and SCHIP Partnership Initiatives. In addition, the AAP supports projects that enable all children to have access to a Medical Home. Included in the definition of a Medical Home is the need for “culturally competent” care. The following CATCH and Healthy Tomorrows project summaries provide examples of the provision of culturally effective pediatric care.

Medical Home Project (MHP) Experiencia Cultural (1998 CATCH Planning Funds)

The CATCH Planning Funds grant will be used to conduct a needs assessment and plan for increased access to medical care for children from the Balsz School District in Phoenix, AZ. Cultural competency, parental empowerment, and resource identification will be the focus of planning for increased access to medical care and eventually a medical home for all children in the community. This community was chosen because of:

1. the number of children without health insurance;
2. the number of households with income falling into the qualifying criteria for the MHP;
3. the number of parents or guardians of school-age children who speak only Spanish;
4. the school nurses’ willingness to participate;
5. the geographical proximity to the MHP office location.

Cultural Competency in Colorado Communities–4-C’ing the Future (2001 CATCH Planning Funds) The 2000 US Census demonstrates rapid immigration to all major cities, Denver included. New demographics pose barriers to care regarding differences in language and culture. Overcoming these barriers will require a collaborative community effort to identify the special needs of the pediatric patients and families. The purpose of the project is to assess the changing needs of pediatric providers, patients, and communities, and develop a plan for educating the practitioners to improve cultural proficiency and promote culturally sensitive care in pediatric medical homes. The project will strive to strengthen community partnerships in order to develop an infrastructure that improves access to care for at-risk, immigrant families.

Vietnamese Family Support Project (2000 CATCH Planning Funds)

The project proposes to:

1. Identify specific areas of parenting needs by surveying families, pediatricians, community clinics, and grassroots organizations—120 households, 30 community leaders and physicians;
2. Develop a community network to address the issues;
3. Identify most appropriate tools for parenting education and vehicles for delivery.

Vietnamese parents are mostly unaware of existing resources and unwilling to access them because of language and cultural barriers.

Linking Migrant Refugee Children to Health Care (2000 CATCH Planning Funds)

The Kitsap Prenatal & Young Child Health Care Council, a network of organizations concerned with child health, will develop a culturally relevant action plan to link Hispanic immigrant and refugee children from birth to 18 years with child health care providers in Kitsap County, Washington. First, this population will be more accurately described through key informant interviews. Then an action plan will be developed with the assistance of a consultant on culturally competent practices and representative parents. The action plan will be based on meeting the needs and reducing barriers identified by the parents of the target population through focus groups.

To learn more about the CATCH Program and CATCH Planning and Implementation Grants, please visit the CATCH Web site. (www.aap.org/catch/index.html)

Better Regional Access for Immigrants and Refugees With Developmental Disabilities (2002 Healthy Tomorrows)

Families of children with developmental disabilities (Down syndrome, autism, cerebral palsy, mental retardation) must negotiate a complex system of evaluation and documentation to access services. These families face incredible emotional and practical challenges. Language and cultural differences in immigrant and refugee families compound these challenges and increase their feelings of isolation. One of the greatest needs expressed by parents of children with developmental disabilities from refugee and immigrant communities is the need for more information and culturally appropriate advocacy and referral services. The goals of this project are to: (1) form support groups for parents from refugee and immigrant communities with children with developmental disabilities to provide emotional support and practical advice, (2) provide comprehensive community advocacy and case management services for participating families, (3) provide outreach to parents of children who have not presented to care, (4) develop a clearinghouse of information about services for children with developmental disabilities, and (5) increase awareness of developmental disabilities within the targeted communities. For each language group, the project will train a bilingual/bicultural family advocate who will organize the support group meetings to provide emotional support, practical information, community advocacy, interpretation, and referral services.

Teen Program at Mary’s Center for Maternal and Child Care, Inc (2002 Healthy Tomorrows)

The purpose of the Mary's Center Teen Program is to address the problem of pregnancy prevention among low-income immigrant teens - primarily Latinas - in the District of Columbia. The Teen Programs' holistic approach employs the following strategies: 1) voluntary case management and counseling services for female teens ages 13-21 and their male partners; 2) twice monthly low-cost Saturday Teen Clinics where teens receive physicals, annual exams, pregnancy testing, family planning, and STD/HIV testing from pediatricians; 3) preparation of individual education plans and referrals to education resources such as English as a Second Language classes; 4) peer educators receive weekly training and present health education sessions at local high schools; 5) regular health education events such as monthly birthday celebrations that includes a guest speaker on a health education topic; and 6) monthly activities (such as special HIV testing days) coordinated between the Teen Program and Mama and Baby Bus that can assist hard-to-reach teens. The bus can serve as a non-threatening mechanism to help bring teens into a primary care setting to access the regular health care services they need. All services are available in both Spanish and English. Through an arrangement with another community clinic, some translation services are available for other languages when needed at the clinic.

Living Healthy – Living Well “Parent Talk” Initiative (2002 Healthy Tomorrows)

The Living Healthy-Living Well "Parent Talk" Initiative is a health promotion and education program which seeks to educate low-income African-American families with school-aged children residing in New York City, NY about the importance of obtaining a medical home and employing preventive health care measures. The program uses a multi-leveled media strategy that includes a radio show and other broadcast media, a national coalition serving as an expert advisory board, internet services, and health education forums. The program will address racial disparities in maternal and child health in the African-American community through the implementation of a culturally relevant health promotion and public information campaign. The initiative also will promote preventive care for children, such as screening for developmental disabilities, dental care, and the elimination of environmental health hazards, such as lead. Additionally, it will encourage parents to undertake safe practices such as putting an infant on its back to prevent Sudden Infant Death Syndrome (SIDS); maintaining a smoke-free environment; and using safety locks on cabinets for families with young children. The program goals are to: (1) educate and raise awareness about racial disparities in maternal and child health outcomes, particularly those identified in the Healthy People 2010 objectives; (2) promote prevention and child safety practices using Bright Futures and the American Academy of Pediatrics guidelines as resources; (3) develop a citywide culturally relevant media strategy for disseminating family and child health promotion information to poor and low-income African-American families; (4) foster a cooperative initiative through the National Black Family Promotions Coalition and other professionals from the fields of health, education, social service, business, and government; and (5) strategize other cost-effective ways to educate the African-American community, particularly those who are poor and low-income, regarding promoting child health and family wellness.

FOCUS: Families of Color Utilizing Services (1997 Healthy Tomorrows)

Children suffer adverse health outcomes, both mental and physical, when they lose a loved one to death. Since 1991, Ele's Place has been creating awareness of and support for grieving children and their families. In an urban setting, the agency is aware of families of color who are in need of services but not fully using the program. The FOCUS at Ele's Place Project (Families of Color Utilizing Services) will increase access to these services to the minority community through efforts directed specifically at recruiting families, facilitators, and clinicians of color. This outreach initiative will be accomplished through collaboration with local agencies, community leaders, and churches in the minority community. Additionally, efforts to provide health care professionals with a theoretical understanding of grieving children and appropriate interventions will expand and intensify

The SEAD (SUPPORT, EMPOWERMENT, ADVOCACY, AND DOULAS) Project (2000 Healthy Tomorrows)

Non-English-speaking immigrant women and their infants face formidable language and cultural barriers to health care, which may result in poor health outcomes. Childbirth represents an especially vulnerable time for these women, who may be unable to communicate effectively with providers during deliveries, or may experience health care providers who are unaware of other cultural practices related to childbirth, resulting in culturally inappropriate care. The SEAD project was developed in response to needs expressed by women with limited English-speaking skills for quality medical interpreting, culturally competent health information, and emotional support during pregnancy, labor, delivery, and early parenting. The project develops leadership capacity among these women, while training bilingual women as doula/medical interpreters to provide prenatal education, medical interpretation, and support during childbirth, postpartum, and at home to new parents. The SEAD collaboration consists of community women and organizations, health care providers, service agencies, the University of New Mexico, and the New Mexico Department of Health. Project objectives include: 1) Improving birth outcomes and breastfeeding rates among women with limited English-speaking skills; 2) Empowering community women to improve their own health and the health of their families; and 3) Increasing local health care systems' multi-lingual and multi-cultural perinatal services for women.

To learn more about the Healthy Tomorrows Program, please visit the Healthy Tomorrows Web site. (www.aap.org/commpeds/htpcp/index.html)

Haitian-American SCHIP Access Program (SCHIP Enrollment Project)

A substantial proportion of Miami's culturally diverse population is low-income Haitian-American. Enrollment rates for Haitian-American children into Florida's version of SCHIP, KidCare, are meager when compared to their population proportion. This program uses a pediatric mobile clinic as a means to access, identify, and enroll qualifying Haitian-American children into KidCare and collaborates with community agencies with a history of serving the target population.

REACH OUT (SCHIP Enrollment Project)

This program is an effort of University of South Florida pediatric residents in their rural tract to increase SCHIP enrollment. The target population is uninsured children cared for by Lawton Chiles Children and Family (LCCF) Health Center in Manatee County, Florida, a rural, agricultural, medically underserved community with a substantial population of migrant workers. Local efforts faced barriers of language, family literacy level, poor understanding of the system, and transportation. The REACH OUT program objectives are to:

1. Train local trainers to assist and provide outreach for SCHIP enrollment;
2. Educate families using language-sensitive personal interaction, video, and brochures; and
3. Collaborate and partner with local organizations.

To access information and resources for the provision of a medical home, please visit the web site of the National Center of Medical Home Initiatives for Children with Special Health Care Needs (www.medicalhomeinfo.org/)

• Culturally Effective Care Articles and Reports (scroll down to "Culturally Effective Care")

To find out more about SCHIP Partnership Initiatives, please visit the website of the SCHIP Partnership Initiatives (www.aap.org/commpeds/schip/index.html)