By KRISTA CONGER
Ask the kids at Santa Clara County’s juvenile hall about homelessness, and they’re likely to tell you it can mean more than not having a place to sleep at night.
Even those with a permanent address can suffer from the lack of a medical home — a network of physicians and clinics to provide regular, essential medical care for problems as diverse as sexually transmitted diseases, depression and substance abuse.
For some kids, their run-in with the justice system at juvenile hall marks the first time in years their medical needs have been evaluated and treated by professionals, such as pediatric residents from Lucile Packard Children’s Hospital. But the benefits of this concentrated attention often end when the child steps back onto the streets and out of the grasp of those trying to help.
Pediatric resident Arash Anoshiravani, MD, would like to change that pattern.
"One of the things we do here at Packard is that we never let patients leave without scheduling a follow-up appointment," he said, adding he’d like to see similar medical arrangement for kids in juvenile hall. In addition to securing follow-up treatment at discharge, Anoshiravani would like to distribute cards to youths before discharge with contact information for public health organizations and community groups that can assist at-risk youth.
Anoshiravani’s vision of a seamless medical transition between the justice system and the community may soon be more than just wishful thinking, thanks in part to a recent grant from the American Academy of Pediatrics’ Community Access to Child Health, or CATCH, Program. Anoshiravani and another Packard Children’s Hospital pediatrics resident, Joyce Javier, MD, are two of only 33 recipients of CATCH grants. The grants seek to aid pediatricians to initiate innovative, community-based proposals to increase children’s access to health care. Anoshiravani and Javier each received $3,000.
"This is the first time I know of that anyone at Packard Children’s Hospital has received a CATCH grant," said Lisa Chamberlain, MD, general pediatrics fellow. Chamberlain supervises the required course for pediatric residents in advocacy training that jump-started both Anoshiravani and Javier on their projects.
While Anoshiravani is focusing his efforts on teens in trouble with the law, Javier is aiming to prevent teen pregnancy and sexually transmitted diseases in Asians and Pacific Islanders. Although overall teen pregnancy rates are decreasing in California, the numbers are more ominous when the data is broken down into different population groups.
"One group, Filipinas, is at particularly high risk," said Javier. Her position as both a physician and a fellow Filipina gives her a unique opportunity to act as a bridge between children and parents reluctant to discuss sexual issues. "Culturally, this is a very difficult topic," said Javier. "Many members of this community are not even aware this is a problem."
Javier has already worked extensively with the Filipino Youth Coalition of San Jose to target at-risk adolescents in middle and high school. She’s planning to use her CATCH grant to organize and fund a one-day conference for parents and teens to outline the problems and facilitate discussion within the community.
Anoshiravani and Javier are also both considering adding outcomes research to their to-do list, which would enable them to quantify potential benefits of their programs and allow future publication of their results.
Chamberlain will continue to work with Anoshiravani and Javier to help them focus their projects to meet the needs of the communities they are meant to serve. Javier has taken this to heart and plans to solicit advice and participation from those she’s trying to help.
"I’d like to get the youth involved and find out what they feel are the most important issues," she said.
Training program helps residents cope (10/17/02)
Stanford Report, January 15, 2003