Archive for March, 2021


    Early Childhood Learning – Brain Science and the Effects of Stress and Trauma

    Rachel Lipman (GU Certificate in Early Intervention ’20) March 29, 2021

    For a developing child, the value of family-centered care and the impacts of trauma on childhood learning are linked. Trauma occurs when children are exposed to events of situations that overwhelm their ability to cope with what they have just experienced. This definition is a powerful reminder that trauma is individualized and providers need to be aware that we all experience and respond to trauma differently.

    According to American Speech and Hearing Association (ASHA) family-centered care is a

    “collaborative approach to the planning, delivery, and evaluation of clinical services” which involves a “mutually beneficial partnership” for family members and providers”.

    Each individual is encouraged to share their ideas, knowledge, and experiences. The benefits of this approach include developing rapport and ensuring that the family members, the individuals, and the providers are all actively involved in service delivery (ASHA, 2020). For families who may be in highly stressful, traumatic circumstances clinician’s expectations for family participation takes on an additional dimension. How do service providers respond to or engage families in the process when it may appear that the family does not have a positive dynamic?

    All young children rely on family members for basic needs such as shelter, meals, and safety, appropriate physical contact, love, and communication. Young children assume that relationships include emotional attachment, progressive complexity, reciprocity, and a balance of power. The role of the early intervention service provider includes helping caregivers to provide those elements to affect skill development. Recognizing a family’s circumstances, respecting their perspectives, and engaging in a reciprocal, honest, trusting relationship is critical to mediate the effects of trauma.

    Family-centered care involves mutual respect, accurate and appropriate information sharing, participation, and collaboration. This concept is powerful to me as a provider reminding me that our first task in serving young children with disabilities or delays is to create meaningful relationships with families. In order to create environments that support child development, the clinician must meet the child and family where they are for that given day/session. For instance, a family member may be preoccupied with finding appropriate housing for their family and is not able to focus fully on caring for their child and therefore, the provider’s child-directed services may not be effective. Families have complex needs, thus most effective service provision is a team-based model. Providers need to be able to rely on team members creating integrated plans that address the family needs and priorities. When used appropriately, while incorporating the needs for the child, the family members, and the provider, family-centered care is a model for service provision that allows collaboration in the best interest of the child.


    Read More

    Physician as Advocate

    Sarah Berg (M’21) March 15, 2021

    The responsibility of a physician is not limited to just providing medical care. While that is obviously a central tenant of our profession, I think it is diminutive to imply that our responsibility to our patients and communities is confined strictly to the walls of a hospital, office, or clinic. We know the health of individuals is more significantly impacted by social determinants of health than they are by the care that we provide.1 In fact, it is clear that a person’s socioeconomic factors, demographic characteristics, and health insurance status can be just as predictive of outcomes as their genetic predispositions and vital signs.

    This intricate interplay between social and economic policy, medical care, and health status highlights the central role of physician advocates in our health care system moving forwards. As experts in the field, who have dedicated their lives to improving the health and well-being of patients and communities, physicians have an obligation to advocate for underserved and marginalized groups. This must extend to our statehouses, courthouses, schools, and businesses. We have a duty to fight for everything from healthier environmental policy and cultural competency training, to expanded insurance coverage and increased access to treatments and cures.

    I’m putting advocacy into action on behalf of individuals with disabilities, an increasingly large segment of the population that has been discriminated against, stigmatized, and mistreated. People with disabilities account for 26% of the American population and are high utilizers of the healthcare system.2 However, they are 10x more likely to report a "fair or poor" health status compared to individuals without disabilities, have higher rates of risk factors for poor outcomes, and are less likely to receive preventive care and routine health screenings.3,4 With this in mind, medical schools must make a concerted effort to highlight the unique social, cultural, and medical needs of people with disabilities, something that only 52% of schools do at this time.5 While I know there won’t be a quick fix to this issue, I’m ready to face it head on.

    But advocacy can be daunting, too. It is an ever-expanding idea in which each person can play an important role. So, how do we get started? What does “being an advocate” mean in practice?

    To me, advocacy means being a student, committing oneself to learning about the culture and needs of underserved communities. It means being a researcher, analyzing data to further our understanding of the vast intersections of medicine, social science, economics, and policy. It means being a community organizer, facilitating change through the collective engagement and action of those in our neighborhoods. And advocacy means being a leader, ensuring that the disparities and injustices which have become far too commonplace do not stay that way, but rather rise to the forefront of our minds, our practices, and our goals, in order to be addressed.

    As a soon-to-be physician, I’m excited to begin my professional career at a time in which the importance of advocacy cannot be overstated. I hope you’ll join me, because we have plenty of work to do.

    References
    1. Artiga, S., & Hinton, E. (2018, May 10). Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. Retrieved February 25, 2021, from https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/

    2. Disability Impacts All of Us Infographic. (2020, September 16). Retrieved February 22, 2021, from https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html.

    3. Iezzoni, L.I. (2011, October). Eliminating health and health care disparities among the growing population of people with disabilities. Health affairs (Project Hope), 30(10), 1947-1954. https://doi.org/10.1377/hlthaff.2011.0613

    4. Altman B and Bernstein A. (2008). Disability and health in the United States, 2001–2005. Hyattsville (MD): National Center for Health Statistics.
    5. Seidel, Erica & Crowe, Scott. (2017). The State of Disability Awareness in American Medical Schools. American Journal of Physical Medicine & Rehabilitation, 96, 673-676. https://doi.org/10.1097/PHM.0000000000000719
    Read More