Pediatricians Bring Health Education to Rural Teens and Tweens

If you could go back to middle school, would you? Most of us would probably say no. A few short years pack in tremendous physical, social, and emotional changes, which makes it an especially tricky time for children. It’s even harder for kids who live in poverty, lack consistent access to healthcare, or both. 

Zoom in on Toppenish, a rural community in the Yakima Valley of central Washington: The median household income is $68,000, and 27% of children in this agricultural area live below the poverty line. More than 91% of residents identify as Hispanic or Latinx, with another 5% identifying as Native American. Each of those socioeconomic factors make it less likely that children will be able to stay on track with well-child visits. 

Bringing Pediatric Health Education to Underserved Communities 

Four pediatric trainees at the University of Washington’s Seattle Children’s Hospital Pediatric Residency Program devised an innovative way to get kids some of the information shared during well-child visits without requiring a trip to the clinic. The team, comprising Dr. Kathleen Goodwin, Dr. Hannah Benjamin, Dr. Alexa Mason, and Dr. Blair Stiers, funded the project through a CATCH Resident Grant supported by the AAP Council on Community Pediatrics and donations to the Friends of Children Fund. 

Dr. Goodwin and team organized the program around a keen observation: Middle-schoolers tend to get short shrift with after-school programming compared to elementary and high school students. The residents could help fill that gap while also supplying the students with essential evidence-based health information. They partnered with the 21st Century Community Learning Centers, a federally funded after-school program at the Safe Haven Community Center in Toppenish, to host the series. 

Health Empowerment for Adolescents in Toppenish (HEAT) was born. 

Well-Child Topics in Focus 

HEAT spanned ten sessions, each of which centered on a topic typically addressed at a well-child visit between the ages of 11 and 14. Forty students enrolled in the program, which featured interactive content and hands-on activities that covered: 

• Human anatomy and body vocabulary
• Sugar-sweetened beverages
• Personal and oral hygiene
• Healthcare careers
• Handwashing, germs, and viruses
• Physical activity
• Mindfulness
• The benefits of spending time outdoors and in nature
• Drugs and alcohol
• Anti-bullying 

Community organizations such as Toppenish Schools, Yakama Nation Tribal Health Services, and Heritage University, a nearby college, contributed to the program. The team secured donations for take-home items that reinforced the lessons, such as toothbrushes and toothpaste provided by the Yakima Valley Farm Workers Clinic mobile dental clinic. 

Indeed, the students themselves said they learned a lot about the effects of drugs and alcohol, the importance of exercise, how to deal with bullies, and even what they might expect from a career in healthcare. At the final session, eight out of nine students said they planned to use their newfound knowledge in the future. 

Scaling Health Education Across the Yakima Valley 

But a successful first year was just the beginning. Several other school districts within the Yakima Valley said they wanted to adopt the HEAT curriculum. The residents created a facilitator guide that outlines each session, including the content, objectives, activities and supplies, and pre- and post-program surveys so others can easily recreate the course. 

Following in the footsteps of the initial grant recipients, Dr. Lucy Coville teamed up with three other residents to keep the program going into 2025 while expanding the curriculum and adding a high school partner. And, knowing that true behavior change is more likely to stick when the whole family works together, the original group of residents is working on broadening the program to include four family nights. 

In an ideal world, every child would go to every recommended well-child visit. In the reality where that isn’t always possible, pediatricians are hard at work ensuring kids still get the information they need to thrive.