Community Comes First
Elizabeth Miller, a medicine/pediatrics physician and medical anthropologist, is Director of Adolescent Community Health at the Massachusetts General Hospital (MGH) Revere Health Center. In that role, she directs the school based health center, teen programming (including an after-school youth center and a school-based dating violence program), and functions as the school physician for the city of Revere. At Harvard Medical School, she is the Associate Director of the Division of Service Learning and Faculty Chair of Community Service Programs, where she teaches and oversees student community service projects.
For Elizabeth, community comes first. She says, This is not about us (at the medical school or at the hospital), but its about the privilege of working with people in communities we serve. Because of her background in medical anthropology, Elizabeth has a unique perspective on the challenges of providing cross-cultural care and on the effects poverty has on the lives of the people she works with and cares for. CCPH is a critical resource and clearinghouse in her work in community health and community-campus partnerships. Right now, my favorite part of CCPH is the CBPR listserv but I also LOVE reading the newsletter, and get lots of ideas and grant information from this.
To sign up for the CBPR listserv, visit https://mailman1.u.washington.edu/mailman/listinfo/cbpr.
is the mission of your organization?
A: The Massachusetts General
Hospital (MGH) Revere Health Center's Adolescent Health Initiative strives
to provide comprehensive, holistic care for adolescents in the socially
disadvantaged community of Revere, Massachusetts-increasing access to
care, celebrating the strengths and diversity of youth, and nurturing
social networks of youth. The Initiative links school-based and confidential
clinical services with a youth development after-school program (called
the Youth Zone), with the support of multiple community partners, including
the schools, police, mayor's office, and key community representatives.
The Youth Zone provides a wide variety of preventive, educational, recreational,
and vocational planning programs and resources that facilitate the development
of the innate strengths found in all youth.
A: What has been most astounding for me over the last eight years has been observing the process of how this program has grown from a small after school program with a once-a-week clinic to a fully staffed, busy five-day-a-week confidential clinic, school-based health center, and teen after-school program. This growth is attributable to a collaboration between a few dedicated people within the main Revere Health Center (a teaching-hospital-affiliated community health center), who are committed to providing excellent care to adolescents, and a group of like-minded community participants and key leaders-a Revere substance abuse coalition, the police, the schools, and the mayor's office. We have been able to develop and nurture trust within this community; as an example, the mayor's office offered us the use of a much larger, more centrally located building for the teen after-school program when we were outgrowing our original space.
A: I love to take care of young
people. Although my clinical practice is a medicine/pediatrics primary
care practice (from newborn to the elderly), I get the biggest thrill
taking care of youth, learning from them about how they view the world,
and encouraging them to draw on their assets. I also feel very privileged
to work with a lot of people in the Revere community who are dedicated
to supporting more resources for adolescents. I love to be involved in
coalition building, and being involved in local advocacy. I enjoy also
finding some skills that I can offer to various community partners, particularly
certain research and evaluation related work. Finally, I have opportunities
to work with medical students and residents, and feel very strongly that
one can teach students through service to embrace social responsibility
as a component of professionalism and their own professional identities.
I LOVE hearing students talk about how their service experiences have
changed their world views and career plans!
A: I want to ensure that the
resources available to youth continue to grow in this community, and that
there are high quality after-school programs, job training, and activities
available. One of my big hopes for this organization is to see the Adolescent
Health Initiative reach many more adolescents in this community, and that
we continue to provide the highest quality services and supports to help
these youth succeed and be healthy. So, one dream is to have a steady
stream of funding (ok, dream on!) and for many more stakeholders to be
involved in order to sustain this work. While the teaching hospital continues
to support some of the staff involved, I would like to see this work become
increasingly more community-based and develop greater sustainability.
A: Relationship building and community organizing take time. So, I guess one lesson learned is to be patient.
And a related lesson to that is, take the time to learn from the many stakeholders involved and actively seek input-the rewards are immense.
For students and others just
entering into the field, I can't emphasize enough to practice the basic
principles of community-oriented care, to reflect on social responsibility
and humility as critical characteristics of one's professional life, and
to identify the champions and key stakeholders early on.
A: When I first started, the
big challenge was getting buy-in from my own health center's providers
that adolescent care was worth doing and that by increasing access to
care in the community that we were not "stealing" their patients.
At this point, as we have grown, most of the providers have at least acknowledged
that these adolescents are likely to be people who would not have come
to the health center, and that we are doing meaningful outreach.
A: Funding adolescent health focused initiatives (such
as school-based health centers, after-school programs, and youth development
organizations) are cost effective. These programs help kids stay healthy
and stay in school, which means less cost to the health care system and
greater benefit to society in the long run.
A: I first learned about CCPH
when I became involved in overseeing community service experiences for
medical students (at Harvard Medical School) as Faculty Chair of Community
Service Programs and Associate Director of the Division of Service Learning.
I went to the CCPH web site to learn more about what others had done to
build campus-community partnerships, what was being done in service learning,
and just get the lay of the land. I learned an immense amount and our
Division of Service Learning very quickly became members. I think about
CCPH as an incredible resource for anything related to community health
work, whether it is tools and references for particular topics (such as
CBPR), lists of grants and awards, or for examples of model community-campus
A: 1) Community comes first - this is not about us (at the medical school or at the hospital), but it's about the privilege of working with people in communities we serve.
2) Collaborations and partnerships need to be nurtured,
and that means also recognizing that one cannot be complacent about these
relationships and must continuously reflect on the co-learning taking
A: CCPH continues to be a critical resource for me both
in Revere with the work with youth and our coalition, as well as at the
medical school. I use the CBPR listserv regularly, and end up going to
CCPH related resources at least once a week if not more. So the value
of CCPH as a national resource and clearinghouse for work related to community
health and community-campus partnerships that I can point to in my conversations
in clinical, educational, and research settings is immense.
A: Not more than 24 hours in a day, I guess. Trying
to balance the need to see patients at our health center with my administrative
work as the director of adolescent health, teaching at the medical school,
and community based research is incredibly hard
am still working
on this one!
A: I came into community-based work through medical anthropology rather than public health, so I bring more of an ethnographic fascination with social contexts rather than a traditional public health model. So I think some strengths I bring are an appreciation of the challenges of cross-cultural care and concerns about the complex ways in which poverty impacts and constrains the lives of so many of the people we work with and care for. In terms of skills, my qualitative research skills have been invaluable in doing my community-based work.
A: My dad always emphasized how important it was to "do the right thing." So I guess that is one of my motivations. I can't imagine not doing work that involves community partnerships and advocacy, so I guess that's what keeps me motivated.
MGH Community Benefit, Research and Evaluation Team