Child Advocacy update
Providing the best possible care for sick and injured children is the cornerstone mission of Children's Hospital Boston—but because health care issues don't exist in a vacuum, the clinical work done at the hospital is only part of the picture. Children's also educates the pediatricians of tomorrow and conducts cutting-edge research to find answers to medicine's most vexing questions. Yet its mission is even broader: through the Office of Child Advocacy and Community Benefits, Children's reaches into communities and the halls of government to ensure that children are healthy, safe and cared for.
Children's commitment to its neighbors in Jamaica Plain, Roxbury, Dorchester and Mattapan is nowhere more evident than at the Martha Eliot Health Center (MEHC), the community health provider that the hospital has run for nearly 30 years.
For the last 10 years, a special program at MEHC has helped bring Children's community commitment into people's homes while resurrecting a type of service thought to be a way of the past: the house call.
The home visits are part of the Family Network Collaborative, which began as a means of preventing domestic violence, child abuse and neglect, but now offers a list of other services. The case managers and nurses who conduct the home visits provide parents, both new and experienced, with child care techniques and information, such as the importance of breast feeding and seeking routine health care. They also help parents learn to access health care for themselves and their children, and provide education about nutrition and family planning.
Meanwhile, staff attend to the children by assuring that newborns have the proper immunizations and are growing normally. They also connect families to resources like day care, provide information on injury prevention and make sure homes are safe by checking for electric socket covers, fire detectors and other safety measures.
In addition to these elements, the program teaches parents the importance of play, literacy and making a personal connection with their children.
Bettie Fordham-Nolan, RN, BSN, MPH, the program's director, says the personal connections developed between families and staff sets the Family Network Collaborative apart. "We become very close to the families and they become close to us," she says. "The people who use this program always come back to visit whether they need advice or when they just want to share their successes with us."
That success also extends to the program itself. In 1992, a staff of two case managers and one half-time nurse served roughly 25 families, but now 14 case managers, three registered nurses and a psychologist provide assistance to nearly 200 families.
The results of the staff's hard work are showing. The Family Network Collaborative now boasts the highest breast feeding rates in the city, has 100 percent immunization rates for children under 2 and has a lower rate of domestic violence than the MEHC patient population as a whole.
For Marlene McQueeney, a mother of four who has utilized the program's services since its inception, the success goes beyond the numbers. "They're helping me prepare all the necessary papers so my kids and I can move into an apartment of our own," she says. "I've become really close to the people in the program in the last 10 years. They're like an extended family."
Last year, patients came to Children's for more than 18,000 asthma-related outpatient visits. But the problem of pediatric asthma cannot be treated in clinics and emergency departments alone. It is the most common chronic illness in children and adolescents in the United States, affecting about 5 million young people. In Boston, an estimated 8.5 percent of students in public schools have asthma and require the attention of school nurses, and asthma-related hospitalizations are particularly high in lower-income neighborhoods such as Roxbury, Dorchester and Jamaica Plain. To find solutions to the problem of asthma, Children's Department of Child Advocacy has taken its work into the community.
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One highlight of that effort was last summer's Kids with Asthma Can Camp event, a week-long outing for kids with asthma on Long Island in the Boston Harbor. One of a number of asthma events hosted in partnership with the Boston Public Health Commission, the Boston Urban Asthma Coalition (BUAC), the American Lung Association and others, the camp helps kids from 8 to 13 years old learn how to manage their asthma. "The goal of the camp," says Karen van Unen, director of Community Benefits, "is to empower kids with asthma to be healthy and active. We also want to provide a fun experience that educates them about asthma and allows them to learn from each other."
While the camp engages asthma patients and families, Children's Breathe Easy Program, which Children's initiated in partnership with the BUAC, works with care providers. "The program aims to reduce the disparities of asthma in Boston and to improve asthma management in primary care practices, schools and homes," says M. Laurie Cammisa, Esq., vice president of Child Advocacy. To accomplish this goal, Children's Hospital has partnered with providers at community health clinics and school nurses at Boston Public Schools. These partnerships make managing asthma easier by providing tools, resources and training to improve care at the community level.
While responding directly to the need for resources is a key part of Children's community response to pressing pediatric health issues, the Office of Child Advocacy is also hard at work in the halls of government. The department recently mobilized its Children's Advocacy Network—comprising more than 1,000 grassroots advocates for children's health and wellness—to contact their legislators about asthma. At the same time, Children's lobbied the Massachusetts state legislature to fund a crucial study of the growing incidence of asthma in the state, and its particularly high rates in low-income areas. Joseph Carrillo, MD, vice president for Community Health Services, testified during legislative hearings. "Because poor children have higher rates of hospitalization and mortality from the disease," says Carrillo. "It is crucial that we investigate these inequities."
Like most pediatric health issues, the solution to the rising incidence of asthma will not emerge entirely from laws passed or funding granted, discoveries made or patients treated. Children's recognizes that solutions come from each of these places—and the fulfillment of the hospital's mission is only possible by attending to them all.
