Advocacy and Community Pediatrics Curriculum

The advocacy curriculum empowers graduates of our pediatric residency program to respond to health inequities that impact children and their families at individual, community, regional, national, and global levels.

Our program realizes that pediatric care involves more than the one-on-one interactions in the hospital or clinic setting. Therefore, the advocacy curriculum exposes pediatric residents to our community’s key child health inequities, the sociocultural determinants of health, and many of the varied partners, both lay and professional, who are vital to the health, education, and success of children and families. The advocacy curriculum prepares future generalist and specialist pediatricians to do the following:

Provide an accessible, continuous, comprehensive, family-centered, coordinated, compassionate, equitable and culturally effective medical home for all children and families under their care;
Integrate into clinical practice and advocacy an understanding of the social, cultural, educational, economic, environmental, and other non-medical factors that influence health outcomes for children;
Practice collaboratively as a team member with patients, families and health, human service, and education professionals in the comprehensive care of both typical children and those with special health care needs and in system change efforts on their behalf; and
Promote child health priorities and public health principles within clinics, hospitals, schools, communities, research activities, and advocacy initiatives.

Advocacy training begins during intern orientation with the Community Plunge continues throughout the residency with a Longitudinal Curriculum, and culminates in each resident completing a mentored Advocacy Project.

Dr. Kimberly Montez and Dr. Rebecca Palmer co-direct our Advocacy curriculum, along with a team of dedicated curriculum faculty. The team is happy to answer any questions you may have about the program.

Community Plunge

Our advocacy program begins during intern orientation with a “Community Plunge,” which introduces pediatric interns to the aspects of our community that influence the health, education, and well-being of children.

During the tour, interns see evidence of many needs in our low-income communities.  However, they also see assets including:

Churches
Community centers
Recreation centers
Parks
Restoration of housing/building new homes
Schools
Points of historical pride and significance
Health and human service agencies

After the tour, interns participate in focus groups with people who represent some of the communities seen on the tour. The members of each focus group offer perceptions about their children’s health and health care and what they need from their pediatricians. The insights of our patients can strengthen our approach to health care and our sensitivity to cultural differences. 

The final phase of the plunge is a group discussion and reflection session with members of the faculty.

Longitudinal Curriculum

During the first and second years of residency, residents on several rotations (ambulatory pediatrics, behavior and development, and chronic care) spend time in homes, schools, childcare settings, and community-based organizations with the objective of enhancing their understanding of community health needs and assets and applying this understanding to their own clinical practice. Guided observations, academic sessions, guest lectures, discussions with community and faculty preceptors, and reflection provide opportunities to increase self-awareness and gain insight into the perspective of the children and families who receive various services.

Several online modules offer selected reading, videos, and interactive units on core topics related to pediatric advocacy, including:

Racism, implicit bias, and discrimination
Toxic stress and adverse childhood experiences
Community and public health
Poverty and social determinants of health
Legislation and policy
Early childhood: school health, school readiness, and childcare
Special populations
Global health
Environmental health

Residents also have the option of participating in supplemental advocacy activities, as their schedules and unique interests allow. For example, residents have the opportunity to participate in White Coat Wednesday at our State Capital where they meet with legislators to advocate on behalf of child health.

American Academy of Pediatrics

The AAP North Carolina Pediatric Society has funded several residents to attend the annual AAP Legislative Conference in Washington, DC. Lastly, the residents may participate in a month-long internship in Washington, DC with the AAP Federal Advocacy office.

Pediatric Trainees (SOPT) Resident Program Delegate

We nominate one resident each year to represent us at the American Academy of Pediatrics (AAP). The AAP Resident Program Delegate is asked to increase the level of engagement and streamline communication from the Section on Pediatric Trainees (SOPT) to the residents. The delegate will represent their program and be officially recognized by the Section. Delegates should display advocacy and education interest and/or involvement within the SOPT. The Resident Program Delegate is a one-year term and must be a resident in good standing with the AAP at the time of selection. We encourage and help fund our Delegate so this individual can attend the National Conference & Exhibition. Responsibilities of our Program Delegate include AAP correspondence with program residents/program faculty, participation and contribution in District Newsletter, engage other residents in AAP opportunities, promote the SOPT advocacy campaign locally and nationally, promote SOPT and AAP educational efforts and initiatives, and engage in District Activity. Selection of our Program Delegate is made in August of each year.

Advocacy Projects

The emphasis of the advocacy project, required for all residents, is on creating real and lasting change at a systems level in partnership with others who work with children and families. Through the advocacy project, residents learn the processes involved in systems change: conducting a community assessment, prioritizing health needs, designing effective strategies to meet needs, building effective relationships with collaborators, implementing programs and services, and evaluating outcomes.

Each resident will join a new group advocacy project or select a personal advocacy project during their intern year. Through a mentored project, residents explore relevant resources, stakeholders, and existing system change initiatives related to their interests and passion. Residents set specific goals with faculty and complete one or more action steps in relation to their chosen issue.

Additionally, residents have the scholarly opportunity to present their advocacy project regionally at the NC Pediatric Society’s annual meeting or nationally at the AAP National Conference and Exhibition.&

Recent resident projects have included:

Incorporating education about basic medical information into orientation for new teachers in our school system
Establishing a pediatric food pantry to tackle food insecurity
Founding a county-level collaborative to promote refugee health
Partner with the Period Project to screen for period poverty and provide period products

Medical Legal Partnership

In partnership with the Legal Aid of North Carolina and the Wake Forest University School of Law, a Medical Legal Partnership is embedded into the Downtown Health Plaza Clinic, the ambulatory training site. All patients are screened for the social drivers of health, including health harming legal needs, and those who screen positive are referred to the Medal Legal Partnership in which a lawyer or law student connects with the family to address the health harming legal need. During COVID-19, the Medical Legal Partnership was recognized by the White House for its efforts to mitigate the eviction crisis in our community.

Grant Awards

Our residency program has been recognized locally and nationally for leadership in advocacy through several grant awards:

From 2016-2018 and again from 2020-2023, the Wake Forest Pediatric Residency Program received grant funding from the Duke Endowment as part of the Carolinas Collaborative, both enacted through the AAP Community Pediatrics Training Initiative (CPTI). The Carolinas Collaborative is a residency collaborative of the 8 pediatric residency programs in North and South Carolina to advance community health and advocacy training, which is currently focused on addressing food insecurity.

In 2020, Dr. Dana Ribaudo was awarded an AAP Community Access to Child Health (CATCH) grant for her project, “What You Do Matters” Parenting Program with Imprints Cares, Inc.

Three of our residents were recognized by the Childress Institute for Pediatric Trauma as “Childress Scholars,” enabling them to receive generous funding from the Childress Institute for Pediatric Trauma for their advocacy projects.

Dr. Laura Shashy (Class of 2017): Car Seat Safety
Drs. Magali Calfee (Class of 2016) and Austen Carter (Class of 2016, Chief 2016-17): Water Safety and Education

Faculty Roles in Advocacy

The pediatric advocacy residency program is co-directed by Rebecca Palmer, DO, MPH and Kimberly Montez, MD, MPH, FAAP, who is an Assistant Program Director and an Associate Director for Integrating Special Populations at the Maya Angelou Center for Health Equity (MACHE) at Wake Forest.

Dr. Montez advocates for child health equity nationally as Vice Chair of the AAP Council on Community Pediatrics, is co-authoring policy statements on food insecurity, paid family and medical leave, poverty and adverse police exposures. Locally, Dr. Montez is principle investigator for the Food is Health project, which is focused on mitigating food insecurity within the health system. She is the medical champion for our Medical Legal Partnership, director of the Wake Forest Health Justice Advocacy Certificate Program, a collaboration between the law school and medical school, and co-leads the Health Equity Certificate Program at MACHE. Dr. Montez is committed to training the next generation of child health advocates and enjoys mentoring trainees in advocacy.

Dr. Palmer’s advocacy efforts focus on the hospitalized pediatric patient, with particular interest in social determinants of health and firearm safety. She also champions inpatient volunteer groups which aim to increase positive experiences at the bedside in the form of arts and crafts as well as literacy exposure.

Our pediatric faculty members set the stage for advocacy through their own advocacy efforts, offering potential mentorship for innovative projects.

Additional faculty highlights include the following:

	Kimberly Gayle Montez, MD, MPH Associate Program Director Dr. Montez is the Associate Program Director for the pediatrics residency. She leads the residency advocacy curriculum, mentors residents in scholarly advocacy projects and implements diversity, equity and inclusion initiatives. As an Associate Director of Integrating Special Populations for the Maya Angelou Center for Health Equity, Dr. Montez supports investigators to increase special population representation in research.
	Rebecca Palmer, DO, MPH Assistant Program Director Dr. Palmer works as both pediatric hospitalist and newborn nursery provider. She has a special interest in inpatient advocacy efforts.
	Laurie Albertini, MD Medical Director of Pediatrics at the Downtown Health Plaza Dr. Albertini has expanded access to care for children living in poverty in Winston-Salem. Dr. Albertini has been a longstanding champion of the advocacy curriculum. She recently engaged in legislative advocacy leading to a ban on the use of tanning beds by children under the age of 18 years.
	Jeanna R. Auriemma, MD Co-Director of the Brenner Children's Hospital Helping Opioid Outcomes Together (HOOT) Program Dr. Auriemma has partnered with Dr. Jennifer Check, a neonatologist, to advocate for optimal care for pregnant women with opioid use disorders and continued support of their infants after birth in an innovative program to support developmental outcomes in the first 2 years of life. Dr. Auriemma is also an Assistant Program Director and the Director of Quality Improvement for the pediatric residency program and has mentored residents in quality improvement endeavors related to this special population.
	Joey Skelton, MD Pediatric Gastroenterologist Dr. Skelton has collaborated with multiple disciplines to develop Brenner FIT, to develop one of the most comprehensive pediatric weight management programs in the country. Gail Cohen, MD, a general academic pediatrician, collaborates with Dr. Skelton and extends Brenner FIT’s educational and advocacy opportunities to our continuity clinic.
	Leila Hamzi DeWitt, DO Pediatric Hospitalist As a pediatric hospitalist, Dr. DeWitt strives to combat pediatric food insecurity experienced by families while they remain admitted to the hospital. She has established an inpatient food insecurity screening process for all admitted pediatric families, as well as an inpatient food pantry.
	Meggan Goodpasture, MD Director of the Child Abuse and Neglect Team Meggan directs the child abuse curriculum that emphasizes the role of child protection in pediatric care. She is also a project mentor for our food insecurity advocacy projects.
	Anna Miller-Fitzwater, MD, MPH Director of Reach Out and Read Program (ROR) A champion of literacy, school readiness, population health. Anna also is the North Carolina Medical Director for ROR, an executive committee member of the AAP Council on Early Childhood, and recently joined the NC Pediatric Society’s Board. Dr. Miller-Fitzwater also a leader in our local Medicaid care management organization and co-mentors our ROR resident advocacy projects.