The adverse effects of poverty on health have been well documented. In response, pediatric clinicians have become increasingly focused on mitigating these effects on children’s health.1 In March 2016, the American Academy of Pediatrics (AAP) released the first-ever policy statement on poverty, calling for pediatricians to screen and address poverty and related social determinants of health (SDH).1 Recent research has developed an evidence base for strategies to address SDH in urban practices.2,3 Notably, poverty has grown by 66% in suburban communities over the past decade, double the rate in cities.4 However, comparatively little information is available for pediatricians on how to address poverty in the suburbs, where almost half of US pediatricians practice and where differences in infrastructure and resources may limit the generalizability of strategies successfully implemented in urban practices.5 This Perspective addresses barriers to and opportunities for pediatricians to better support...
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December 2016
Pediatrics Perspectives|
December 01 2016
Implications of Poverty for Practices Serving Suburban Families
Deepak Palakshappa, MD;
aDepartment of Pediatrics, and
bCenter for Pediatric Clinical Effectiveness and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Address correspondence to Deepak Palakshappa, Department of Pediatrics, The Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, CHOP North-1455, Philadelphia, PA 19104. E-mail: palakshappad@email.chop.edu
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Alexander G. Fiks, MD
Alexander G. Fiks, MD
aDepartment of Pediatrics, and
bCenter for Pediatric Clinical Effectiveness and PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Address correspondence to Deepak Palakshappa, Department of Pediatrics, The Children’s Hospital of Philadelphia, 34th St and Civic Center Blvd, CHOP North-1455, Philadelphia, PA 19104. E-mail: palakshappad@email.chop.edu
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2016) 138 (6): e20162548.
Article history
Accepted:
September 01 2016
Citation
Deepak Palakshappa, Alexander G. Fiks; Implications of Poverty for Practices Serving Suburban Families. Pediatrics December 2016; 138 (6): e20162548. 10.1542/peds.2016-2548
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Comments
RE: "formal or informal" Reach Out and Read Programs
To the Editors (and Authors): Thank you for the article highlighting the issues around the issue of suburban poverty, a phenomenon often not recognized in our society. While I appreciate the clear mention of Reach Out and Read as a key element in mitigating the effects of such poverty on children, I was concerned by the qualifier of using "formal or informal" Reach Out and Read programs.
While more detail was not provided, one assumes that "informal" Reach Out and Read programs consist of those where formal application is not made, online training is not undergone, and technical assistance/quality assurance is not obtained from Reach Out and Read National Center or state/metro Reach Out and Read affiliates. Doing an ersatz "Reach Out and Read" generally reduces the program to that of a mere book giveaway and informational campaign. While this may be some value, the powerful evidence base[1] of Reach Out and Read is predicated on the clinician following through on training and using a skilled, intentional observation of the child and caregiver's interaction with, around, and through the book to perform developmental surveillance, assessment of relational health, and as a bridge to enquire about the home psychosocial environment, sleep, etc. [2]
Reach Out and Read may seem like it is about the book, but it is really a model for strong, individualized guidance based on intentional observation. To promote "informal" programs is a misunderstanding of Reach Out and Read and simply does not do the model or the evidence base justice, and ultimately would result in a less-than-best approach to the care these families require.
[1] Reach Out and Read Research. Accessible at: http://www.reachoutandread.org/why-we-work/research-findings/
[2] Navsaria D, Shriver AS. The Elephant in the Clinic. Ascend at the Aspen Institute, October 2015. Accessible at: http://ascend.aspeninstitute.org/pages/the-elephant-in-the-clinic-early-...