2005 Community-Campus Partnerships for Health Award Recipient

Communities & Physicians Together

Represented by:

• Liz Sterba, Child Advocacy Program Manager, University of California-Davis
• Richard Pan, MD, MPH, Associate Residency Director and Associate Professor, University of California - Davis
• Peggy Tapping, Executive Director, Sacramento ENRICHES

Engaging children in a lesson on lice, a CPT Resident one of his Resident Advocacy Projects with the Tahoe/Colonial Collaborative

Communities & Physicians Together (CPT) is a partnership that draws upon the assets of communities and physicians-in-training to improve child health and support families in raising healthy children. Employing the principles of asset-based community development, CPT teaches pediatric residents how to identify community assets and resources, build partnerships with community collaboratives, and leverage these partnerships to enhance the capacity to improve child health in each community. The partnership is guided by their vision: "All children deserve the opportunity to achieve their physical, mental and social potential. Pediatricians have a broad responsibility to optimize child health and development by helping build capacity in communities and supporting families. CPT strives to give every child a healthy present and future by teaching pediatricians, both in training and in practice, how to make a difference through active community partnerships to support families in raising healthy children." The partnership is comprised of five volunteer community collaboratives in Sacramento & Yuba Counties; the University of California, Davis Department of Pediatrics; the American Academy of Pediatrics Community Access To Child Health (CATCH) program in California; and Sacramento ENRICHES (Engaging Neighborhood Resources for Improving Children's Health, Education and Safety). Since the establishment of CPT in 1999, 54 pediatric residents and faculty have addressed an array of community-identified concerns, including obesity prevention, safety education, and health education in immigrant and minority communities. Evaluations of CPT have shown that community leaders value their participation in CPT and view the pediatric residents as assets to the community, while at the same time pediatric residents gain an understanding that working in partnership with communities allows physicians to impact health and fitness in a much broader manner.

History

During his first year with the Sacramento Head Start Alumni Association, a resident volunteered to help with the Families CAN Garden project, where children and families were taught to grow and prepare healthy foods.

CPT was implemented in 1999 by the University of California, Davis Department of Pediatrics' Pediatric Residency Program (UCD) in partnership with five community collaboratives. The collaboratives were identified using a connection between the California chapter of the American Academy of Pediatrics Community Access To Child Health (AAP CATCH) program and Sierra Health Foundation's Community Partnerships for Healthy Children (CPHC) initiative. These five collaboratives agreed to become training sites - real-world classrooms- for the residents. As part of the CPHC initiative, each Collaborative had previously been trained in and were using ABCD, and therefore, CPT adopted this asset-based approach as the conceptual basis for the program, using New Community Tools for Improving Child Health: A Pediatrician's Guide to Local Associations as a guide. The residency program provided administrative support and collaborative members donated their time until extramural funding was obtained through the Anne E. Dyson Community Pediatrics Training Initiative in 2002.

Partnership Goals

The overall vision of Communities & Physicians Together (CPT) is "All children deserve the opportunity to achieve their physical, mental and social potential. Pediatricians have a broad responsibility to optimize child health and development by helping build capacity in communities and supporting families. Communities & Physicians Together (CPT) strives to give every child a healthy present and future by teaching pediatricians, both in training and in practice, how to make a difference through active community partnerships to support families in raising healthy children." CPT has four main goals:

• Form strong and reciprocal relationships between Pediatric Residents and their assigned communities;
• Increase involvement of community physicians in community collaboratives and in CPT;
• Create and present formal curricula and education opportunities to residents, faculty and the community; and
• Document program efficacy and increase program awareness.

A long-time community leader & activist (center), spends time at Colonial Park in the Tahoe/Colonial Collaborative community with two CPT Residents during their first year Advocacy Rotation

The cornerstone of the program is the longitudinal and reciprocal experiences of pediatric residents within collaborative communities. In addition, outreach to government and community-based agencies serving children and their families open additional educational opportunities for the residents to learn about existing services. Each resident partners with one of the community collaboratives where s/he is educated to the value of child advocacy as an essential role of a pediatrician. Through this partnership, each Resident is oriented to their specific community, and then work with the collaborative and their colleagues to develop and implement a child advocacy project for the community. CPT Residents spend three years with their Collaborative communities. Their first year - a full-time, two-week rotation - is spent learning about the Collaborative, its community, and the people and assets that it has to offer. The second year Advocacy Rotation is a four-week, part-time rotation during which the Resident works with the Collaborative to develop and implement a Resident Advocacy Project, based on the interests of both the Resident and the Community. The third year is another two-week, full-time rotation where Residents wrap up and evaluate their Resident Advocacy Project.

The Partners

Community Partners: The community partners include five community collaboratives. A Community collaborative is a neighborhood "association of associations" consisting of community residents, students, professionals, business owners, voluntary associations, and government agencies. The community partners serve as community "faculty" in teaching residents about grassroots community building & development and child & family advocacy

• Children First - Flats Network (CFFN): Located in the downtown area of Sacramento County, this collaborative serves children and families in the Alkali Flats and Mansion Flats communities. CFFN has been functioning since 1995 and its primary focus is "creating a sense of community to improve children's health." CFFN includes neighborhood residents, Boys & Girls Club of Greater Sacramento Thomas P. Raley Branch, California State University- Sacramento Barrio Arts Program, City of Sacramento, County of Sacramento, Washington Elementary School, and Washington Neighborhood Center.
• Cordova Community Collaborative for Healthy Children and Families (CCC): This collaborative is a non-profit program of the Folsom Cordova Schools Foundation. CCC was formed in 1994, with the mission of strengthening families and linking them to community resources that enhance self-reliance and promote community involvement. CCC includes neighborhood residents, Afisha Russian Multimedia Association, Folsom-Cordova Schools Foundation, Folsom-Cordova Unified School District, Rancho Cordova Birth & Beyond, Rancho Cordova City Council, Rancho Cordova Neighborhood Center, Rancho Cordova Weed & Seed Association, Sacramento County Department of Human Assistance, Sacramento County Sheriff's Department, STARS After school Program, Theodore Judah Family Clinic, and White Rock Family Clinic.
• Sacramento Head Start Alumni Association (SHSAA): The mission of this collaborative to utilize the talents of past Head Start Parents and Staff to help current parents with kindergarten transition, promoting advocacy on their children's behalf, and to provide a network of resources and referrals. SHSAA works to provide a network to support families by providing resources, referrals, and case management to meet their needs. SHSAA includes neighborhood residents, Head Start, Heritage Institute for Family Advocacy, Women's Civic Improvement Center, Rio Linda Union School District, Community Resources Project, Brodgers Graphic Arts, Tech Printing, Horizon Organic Foods, Sacramento Rivercats, and AmeriCorps.
• Tahoe/Colonial Collaborative for Healthy Children (TCC): This collaborative, located in the southeast area of Sacramento County, has served and advocated for children and families in the Tahoe Park, Colonial Park and Oak Park communities since 1994. TCC's mission is to "make our neighborhood a healthy and safe place to live where children can ride their bikes and play without worry of harm. It is our hope to provide services and activities that bring adults and children together to create a small-town atmosphere where people greet each other by name and aren't afraid to walk down the street after dark. It's not about being in the right neighborhood. It's about making the neighborhood right." TCC includes neighborhood residents, City of Sacramento, Colonial Park Arts & Recreation Effort, County of Sacramento, Dunlap House Birth & Beyond, Healthy Start, Mark Twain Elementary School, Sacramento City Unified School District, Sacramento County Department of Human Assistance, Sacramento Housing & Redevelopment Agency, Tahoe Elementary PTA, Tahoe Elementary School, Tahoe Park Neighborhood Association, and The California Wellness Foundation.

• Community Members from the Sacramento Head Start Alumni Association stand at their booth, ready to share their Collaborative-Resident projects

  Yuba Community Collaborative for Healthy Children (YCCHC): Formed in 1994, this collaborative brings a grassroots, asset-based community development approach to improving children's health and well-being. Through local resources and an alliance with residents, YCCHC is developing projects that will have a significant impact on the health of in our community. YCCHC includes neighborhood residents, Alicia Intermediate School, Camptonville Resource Center, Cedar Lane Elementary School, Cedar Lane Family Resource Center, First Five Yuba County, Harmony Health Family Resource Center, Linda Elementary School, Olivehurst Family Resource Center, and Yuba County Family Resource Center.

Institution Partners

• Adopt-a-School Program, Sierra Sacramento Valley Medical Society: places physician, and medical student volunteers in local elementary, middle, and high schools to augment preventative health education to staff and students.
• American Academy of Pediatrics, CATCH Program: national program designed to improve access to health care by supporting pediatricians and communities that are involved in community-based efforts for children.
• Community Pediatrics Training Initiative (Funding, technical assistance): designed to collaborate with academic pediatric training programs working to develop educational curricula and scholarly efforts concerning community-oriented & community-based health care. Through this Initiative's interdisciplinary collaborations and community partnerships, pediatric academia and residents will be equipped with the tools and knowledge they need to become future professionals committed to improving children's health in their community.
• Health Education Council (School Health program)
• Sacramento City Unified School District (School Health program)
• Sacramento ENRICHES: ENRICHES (Engaging Neighborhood Resources for Improving Children's Health, Education, and Safety) is a community-based collaborative working to influence public policy agendas and public norms, and increase public awareness of issues that impact the health and well-being of children and families.
• Sierra Health Foundation
• University of California, Davis, Department of Pediatrics

Strong Partner Involvement Strategies

Promotion of service-learning as a core component of health professions education.

All pediatric residents at UC Davis participate in CPT, which has created a culture of service learning in the program. Each resident is expected to form a longitudinal and reciprocal relationship with their CPT community throughout residency and has six weeks scheduled for CPT activities. Residents are taught to reflect on their experiences working in their community to serve children and families - and are expected to do so not only on their own but through dialogue with their Collaborative Coordinators and other community members. In addition, the residents are provided with a formal curriculum on important concepts in community pediatrics to reinforce what they learn from their service projects. CPT is working to expand CPT to involve medical students and residents in other specialties including family medicine and child psychiatry.

Advocacy for policies needed in the public and private sectors that facilitate and support the partnership

CPT partners have worked to garner support from local and state government officials, top executives from private companies, and philanthropies. Several Community Collaborative coordinators have also taken strong roles in local policy efforts related to children's health. On the national level, CPT Director, Dr. Richard Pan, has been a national leader in medical education, serving on the American Medical Association (AMA) Council on Medical Education and the Board of the Accreditation Council on Graduate Medical Education, and a strong advocate for service learning, starting the "Grassroots Initiative" as Chair of the American Academy of Pediatrics (AAP) Resident Section.

A CPT resident (right) poses with the Cordova Community Collaborative Coordinator Linda and a Cordova community member after presenting the Weed & Seed Community Survey project at the First Annual CPT Resident Child Advocacy Symposium

Creation of opportunities for individuals and organizations to collaborate and exchange relevant resources and information

• The Resident Child Advocacy Symposium is designed to bring residents, faculty, community partners, local government representatives and outside agencies together to share and celebrate the work of CPT's physicians and community members.
• The Hand-in-Hand Community Awards Evening focuses on thanking one individual, association or institution from each of CPT's five partner communities, who have contributed to residents' community-based learning.
• The CPT Academy, a series of four workshops available to UCD Faculty, community members and local agency representatives, which covers topics such as "Bridging the Community/Physician Culture Gap," and "Planning, Implementing and Evaluating A Resident-Community Project."
• "Quarterly Collaborative Noon Conferences" are times where community physicians, community members and pediatric residents can eat lunch together and share events, opportunities and ideas. This activity not only brings people together face-to-face, but helps facilitate a more longitudinal relationship.

Promotion of the benefits of community-campus partnerships

CPT publishes "The Beat" quarterly newsletter to share information and promote the partnership. Quarterly features include a "Resident Project Focus" and "Community Collaborative Spotlight," where readers are introduced to the players and the work of CPT, in a close-up, in-depth manner. This newsletter, with a distribution list of more than 300 community members, agencies, local government representatives, and UC Davis faculty, is also posted on CPT's website for further dissemination. Additionally, CPT has presented its partnership in many arenas, most recently at the American Academy of Pediatrics' Community Access To Child Health National Conference in August 2004.

Achieving Tangible Results:

The Zdorovie Deti team poses after one of the monthly Healthy Children Russian radio shows. Listeners are provided with information on specific health topics (identified as important by Russian parent focus groups and leaders in the Russian community) and are then given a chance to call in with questions for the CPT pediatric resident.

Initiation and/or sustaining of community-based projects to improve child health. Examples include:

• A pediatric resident with a background in public health developed and analyzed a community survey with a community collaborative that resulted in a federal "Weed and Seed" grant.
• Another resident reached out to the Russian immigrant community by partnering with a Russian language radio station and a parent group to produce a radio show on child health.
• To reduce obesity, a group of pediatric residents and collaborative members partnered with the local minor-league baseball team, an elementary school, and parents to promote physical activity in "Homerun for Health."
• In a rural community, a pediatric resident partnered with an after-school program and local car dealerships to accomplish the same goal in "Yuba Drive for Health."
• To reduce dog bites, another pediatric resident partnered with local dog owners, a school, and the community collaborative to teach dog safety in a park.

Development of curricular materials to teach physicians how to effectively partner with community partners. CPT developed a six-part curriculum on Asset-Based Community Development for pediatric residents and a workshop for community members and community physicians. This training in community medicine and child advocacy benefits not only future pediatricians but also practicing pediatricians who serve as mentors to the residents. The curricular materials have been disseminated nationally at workshops about CPT presented at academic and professional meetings including the American Academy of Pediatrics, the Pediatric Academic Societies, the Dyson Initiative Symposium, and the American Medical Association.

Impact on professional development of pediatric residents and on partnering communities. A qualitative evaluation of CPT is currently being conducted with pediatric residents and collaborative coordinators. Initial results have found that community leaders value their participation in CPT and that pediatric residents gain an understanding that working in partnership with communities allows physicians to participate in projects that impact health and fitness in a much broader manner. Results from CPT's initial evaluation are pending publication in peer-reviewed medical journals.

For more information on the Communities & Physicians Together, contact Liz Sterba at elizabeth.sterba@ucdmc.ucdavis.edu or (916)734-2156.

Partnership Website: www.cpt-online.org

On October 19, 2005, Communities & Physicians Together shared more information
about their award-winning partnership on a teleconference call. Click here to access the
teleconference audiofile, slides and handouts.