Children's Hospital Medical Center

Hani Siddeek, Summer 2011

Well child care is one of those things that may be common sense to most people. Our parents brought us to the doctor as soon as we were born and then followed up with well-child care visits to make sure we were up to date with immunizations and that we were growing properly. To parents this may seem like a requirement in order to have a healthy newborn. After all, studies do show that newborns that attend their well-child care visits are more likely to have a healthy childhood.

Unfortunately this isn't the case with the Price Hill community. Cincinnati Children's is seeing a decrease in compliance in well child care visits: of all the newborns that show up to the Primary Pediatric Care Clinic (PPC Clinic), less than 60% of them return for the two month well-child care checkup. The compliance decreases with the four month check up and six month checkup. There may be a lot of reasons why these babies don't show up for their well-child care checkups: not enough money for transportation, not enough food, parents forgetting about the appointment, the baby maybe seen at a different clinic, etc. Whatever the reason, the underlying concern is that these babies are not showing up for their immunizations as well as other health interventions that are beneficial to a healthy childhoods.

In order to find out more about this problem, I spent some time in the PPC Clinic. The PPC Clinic is located within Cincinnati Children's and sees over 35,000 children visits a year with 15,000 being seen regularly. Of these patients, a majority of them are on Medicaid (~85%) or uninsured (~5%). The services that the PPC Clinic provide include immunizations, well-child care check-ups, screening and treatment of asthma, ADHD/ADD, behavioral problems, lead exposure, and minor illnesses. In addition to these services the PPC Clinic offers public and social services by having legal aid services, social workers as well as nutritionists available on-site. During my time at the PPC Clinic I was able to shadow within these different services (specifically social workers and legal aid workers).

It was with the social workers that I found out about food insecurity, bed bug problems throughout the city as well as several other problems these parents faced. I remember one of my shadowing opportunities where the social worker talked to a deaf mother about her fear of staying in the area she was living in because of a sex offender that was prowling the streets. It was obvious that she was concerned about the well-being of her children and despite her being deaf she was doing the most she can for them.

Having seen all this I gathered information about basic needs resources throughout the community and made a map of those resources along with the eligibility requirements to use those resources. This map will be used by nurses at the PPC Clinic to inform parents where they can get food or housing. This then lead to my project over the summer; I created a brochure that highlighted basic needs resources within the Price Hill community, tips on well-child care and, more importantly, a table so that the parent can keep track of the well-child care appointments. After I created the brochure I went down to the PPC Clinic and asked parents of newborns in the waiting room what they thought about the brochure and if they had any other suggestions for it.

The brochure has not been approved to be distributed yet, however, the efforts to increase compliance with well-child care visits don't end with a brochure and a map. The Department of General and Community Pediatrics is also working on care coordination within the PPC Clinic and their patients. As part of my internship I read up on care coordination and the roles of care coordinators within the health care system. I firmly believe that care coordination can help Cincinnati Children's in its effort to improve well-child care within the Price Hill community.

As an intern I also had the opportunity to attend grand rounds and shadow different specialties within Pediatrics. I was able to shadow in the NICU as well as a pediatric oncologist. Needless to say these shadowing opportunities opened my eyes to the world of pediatrics and gave me some insight as to what specialty I want to practice.

Overall I got a lot out of this internship. From the moment I came to Cincinnati Children's it was obvious that I was going to get a learning experience more so than a volunteering experience. This was evident with the grand rounds I attended, the shadowing opportunities that I had, and the articles that I read. While I may have accomplished some projects that were beneficial to the PPC Clinic, I was also made aware of how much more needs to be done, not just in medicine but in the community. There are many problems outside of health care that factor into a person's health. As a future physician it’s imperative to be aware of my patient’s environment outside of the clinic and I thank Cincinnati Children’s for making me aware of that.