Communities and Physicians Together (CPT) at University of California, Davis Health System provides a novel approach to teaching residents to be effective community advocates. Founded in 1999, CPT is a partnership between a pediatric residency program, five community collaboratives located in diverse neighborhoods, and a grassroots child advocacy organization. Using the principles of Asset-Based Community Development, the program emphasizes establishing partnerships with community members and organizations to improve child health and identifies community assets and building capacity. Community members function as the primary faculty for CPT.The authors describe the CPT curriculum, which teaches residents to build partnerships with their assigned community. Residents have three, two-week blocks each year for CPT activities and maintain a longitudinal relationship with their community. In the first year, collaborative coordinators from each community orient residents to their community. Residents identify community assets and perform activities designed to provide them with a community member's perspective. In the second and third years, residents partner with community members and organizations to implement a project to improve the health of children in that community. CPT also provides faculty development to community partners including a workshop on medical culture and resident life. A qualitative evaluation demonstrated residents' attitudes of their role as pediatricians in the community changed with CPT.CPT is unique because it provides a model of service learning that emphasizes identifying and utilizing strengths and building capacity. This approach differs from the traditional medical model, which emphasizes deficits and needs.
"Sustainable community involvement has been part of a growing movement for two decades. Primary building blocks include local assets in the form of residents' skills and abilities and the supportive functions of local institutions (McKnight and Kretzmann, 1993; Mathie and Cunningham, 2003; Hufford et al., 2009; Russell, 2011). This is in sharp contrast to the alternative problems-orientated needs-mapping approach to deprived and troubled neighbourhoods that has had a devastating effect in some inner city areas. "
[Show abstract][Hide abstract] ABSTRACT: Personalisation was a key element in reform to the Adult Social Care system in England, exploring long-term funding options in response to demographic change where people are increasingly living longer with complex conditions and needs (Department of Health, 2007). Self-directed support is central to this reform to enable recipients of social care to choose and commission their own services. Reform was not expected to require structural reorganisation but local authority leadership was anticipated to promote genuine partnerships between social care providers, users and their carers as well as the wider community. However, there is potential for a shift in power to service users which goes beyond collaboration, especially where there is scope to build long-term relationships around long-term needs.
This study is based on one local authority partner’s innovative development of local communities’ social capital around personal budgets for vulnerable adults, which set out to grasp the potential that personalisation offered in enabling different ways of service delivery that were nearer to what service users and their carers wanted. Although now being addressed, there has been less research into the impact of personalisation on the crucial role of carers than on any other group, which is fundamental to the personalisation agenda reaching its real objectives. The study considers the role played by the local authority in this agenda in the light of claims that reforms are increasingly shrinking the role of the state. Taking an asset-based approach to informal care via social networks, this local authority partner was able to empower a community-run organisation in one of its most deprived and diverse wards by brokering support for vulnerable residents and embracing a neighbourhood perspective to examine collective as well as individual solutions. Conclusions reflect on the importance of the role of the state in achieving community capital.
People Place and Policy Online 12/2013; 7(3):153-167. DOI:10.3351/ppp.0007.0003.0004
"A review of the literature on resident attitudes towards health advocacy revealed few published studies [7,8]. One study in the United States described a community-based advocacy training program for pediatric residents, where residents were assigned in a longitudinal manner to a community collaborative in their first year and eventually implemented a project in their last year of residency . "
[Show abstract][Hide abstract] ABSTRACT: The CanMEDS Health Advocate role, one of seven roles mandated by the Royal College of Physicians and Surgeons Canada, pertains to a physician's responsibility to use their expertise and influence to advance the wellbeing of patients, communities, and populations. We conducted our study to examine resident attitudes and self-reported competencies related to health advocacy, due to limited information in the literature on this topic.
We conducted a pilot experience with seven internal medicine residents participating in a community health promotion event. The residents provided narrative feedback after the event and the information was used to generate items for a health advocacy survey. Face validity was established by having the same residents review the survey. Content validity was established by inviting an expert physician panel to review the survey. The refined survey was then distributed to a cohort of core Internal Medicine residents electronically after attendance at an academic retreat teaching residents about advocacy through didactic sessions.
The survey was completed by 76 residents with a response rate of 68%. The majority agreed to accept an advocacy role for societal health needs beyond caring for individual patients. Most confirmed their ability to identify health determinants and reaffirmed the inherent requirements for health advocacy. While involvement in health advocacy was common during high school and undergraduate studies, 76% of residents reported no current engagement in advocacy activity, and 36% were undecided if they would engage in advocacy during their remaining time as residents, fellows or staff. The common barriers reported were insufficient time, rest and stress.
Medical residents endorsed the role of health advocate and reported proficiency in determining the medical and bio-psychosocial determinants of individuals and communities. Few residents, however, were actively involved in health advocacy beyond an individual level during residency due to multiple barriers. Further studies should address these barriers to advocacy and identify the reasons for the discordance we found between advocacy endorsement and lack of engagement.
BMC Medical Education 11/2010; 10(1):82. DOI:10.1186/1472-6920-10-82 · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A four level atmospheric - ocean - sediments transport model has been coupled to an ecosystem model to estimate the magnitude of effects of ocean-based incineration of PCB wastes. The atmospheric (top) layer of the model has a seasonally variable thickness, a reflecting boundary at the top, and an absorbing boundary at the air-water interface. Upper and lower layers of the oceanic water column constitute the second and third layers of the transport model, while the fourth layer represents the sediments on the seafloor. The ecosystem model focuses on linkages among major trophic compartments, and includes predation, metabolic, and pollutant assimilation and depuration components. Simulation results suggest that, for destruction and removal efficiencies on the order of 0.9999 (four nines), measurable bioaccumulation effects may occur in the benthos over a 50 year policy horizon.
OCEANS '85 - Ocean Engineering and the Environment; 12/1985
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