IMPACT Program

Improving Medicine: Pediatricians and Communities Together (IMPACT)

The IMPACT program is designed for medical residents who are interested in gaining an in-depth and focused experience involving either a community-based intervention or policy work. Participants have dedicated time during all three years of residency to work on developing and implementing a single project. Residents choose from one of three areas of emphasis:
 

  • Community Health Track
  • Global Health Track
  • Quality Improvement Track

Directors: Colleen Kraft, MD, MBA, and Susan Wu, MD

Traditional residency training focuses on improving children’s health through direct medical care. However, it can also be improved on an even greater scale through a multidisciplinary approach that includes community education, physician-community partnerships, urban planning, research and policy change. The IMPACT Community Health Track assists residents in planning and implementing innovative interventions that tackle child health problems from a non-traditional, community-oriented perspective.

Goals

  • To provide trainees with the skills to plan and implement effective community-based child health interventions
  • To appreciate and be able to navigate the social, cultural, environmental, economic, political and human factors that affect the success of community-based interventions
  • To learn skills to lead a multidisciplinary team of academic and community providers
  • To understand the principles of community-based participatory research

Curriculum

In addition to the core IMPACT curriculum, the Community Health Track includes:

  • A public health curriculum
  • Community-based participatory research skills didactics
  • Team training and leadership training
  • Optional advanced media training
  • Optional advanced legislative advocacy training

Directors: Pia Pannaraj, MD, MPH, and Alex Van Speybroeck, MD, MPH

The American Academy of Pediatrics recognizes global health as an important component of general pediatrics residency training. Geopolitical boundaries do not circumscribe health issues and nowhere is this more obvious than in Los Angeles. We serve a diverse patient population that includes immigrant and migrant families, and in many ways, each day in the Children's Hospital Los Angeles wards or clinics is a class in global health. In effect, global health can be a discipline unto itself.

Goals

  • To increase knowledge of the epidemiology, disease processes and management of key diagnoses with significant health impact in developing world countries
  • To challenge residents to critically investigate the economic, social and political challenges affecting health care delivery across varied resource-limited settings
  • To provide short-term and longitudinal experiences for residents to envision and incorporate global health into their future career plans

Curriculum

In addition to the core IMPACT curriculum, the Global Health Track includes:

  • Formal didactics in core global health topics 
  • A longitudinal project focused on global health, which can be research, educational or intervention-focused in scope
    • Residents are encouraged to partner with USC faculty and non-governmental organizations who are already doing work in the country.
  • Minimum of one clinical or research rotation internationally during the PL-2 or PL-3 year
    • Residents will work with faculty mentors to plan the rotation, develop goals and expectations, and complete appropriate pre-work. They are required to complete weekly blog entries and/or a post-rotation reflection paper.
  • Journal club discussion group led by Global Health Track senior residents

More for information, visit our page.

Director: Joyce Yang Koh, MD

While physicians typically treat individual patients, they also have a greater professional responsibility to improve systems of care. This concept has been affirmed by the American Board of Medical Specialties and the Institute of Medicine and is a required component for maintaining Board licensure. One approach to improving health systems is using quality improvement science and tools, which can reduce medical errors, improve efficiency and optimize the quality of care delivery.

Goals

  • To understand quality improvement theory and principles
  • To learn skills and knowledge for planning and implementing a successful longitudinal quality improvement project.
  • To be able to apply basic biostatistical methods, use run charts and control charts for analysis of quality data
  • To be able to critically assess the healthcare system/model of care and understand how changes to any process impacts the whole system.

Curriculum

In addition to the core IMPACT curriculum, the Quality Improvement Track includes:

  • Core quality and safety didactics and skills sessions
  • Training in models of change, team building and leadership skills
  • A longitudinal project focused on quality improvement, which can be focused on any clinical area of interest.
    • Trainees are encouraged to partner with faculty who have clinical expertise related to their quality improvement project. 
  • Optional participation in hospital Quality Improvement committees and projects
  • Optional development or revision of a multidisciplinary clinical practice guideline


IMPACT residents work closely with mentors to perform a needs assessment; design and implement their study or intervention; arrange meetings with key community partners; and complete grant applications. At the end of the project period, residents will evaluate their project in a research framework and present their findings at an academic meeting and Grand Rounds.

IMPACT residents are required to attend a monthly noon conference series separate from the general residency program, focused on child health advocacy, community health, research skills and leadership. Examples of noon conference topics include:

  • Child health policy and legislative advocacy
  • Building community partnerships
  • Conducting a needs assessment
  • Qualitative research methods
  • Quantitative research methods

Many IMPACT residents have ideas for projects prior to joining, but many develop their ideas and interests during the core rotations. Some residents choose to start new projects while others choose to continue and/or expand projects from graduating residents. Examples of past and current projects include:

  • Preventing obesity in an East Los Angeles early childhood center
  • Assessing the impact of south L.A. hospital closures on access to pediatric services
  • Access to mental health services for foster youth
  • Improving special education resources for children with special needs
  • Anti-tobacco education program for minority fifth graders

Project Planning, Implementation and Evaluation

  • 1st Year: Project Planning
  • 2nd Year: Project Implementation
  • 3rd Year: Project Evaluation
  • Two to six weeks to work on the project with mentors
  • Two-week core curriculum: community-based participatory research, asset-based community development, community partnerships, logic model, project design and planning
  • Grant preparation and submission
  • Poster presentation at The Advocacy Poster Session
  • Two to six weeks to work on the project with mentors
  • IRB application submission
  • Grant preparation and submission
  • Project pilot
  • Poster presentation at The Advocacy Poster Session
  • Two to six weeks to work on the project with mentors
  • Program evaluation
  • Sacramento advocacy leadership conference
  • Submit and present abstract at a national meeting
  • Preparation of manuscript
  • Present project at Grand Rounds
  • Poster presentation at The Advocacy Poster Session


Recent IMPACT Projects

  • Community Health
  • Global Health
  • Quality Improvement

Integrating mindfulness training for resilience in K-5 education: An exploratory mixed methods pilot study

There is a disproportionate exposure of low-income youth to adverse childhood experiences, which are known to have a cumulative detrimental effect on long-term health outcomes. Mindfulness training is a promising tool shown to promote resilience in such a population by improving cognitive and emotional control, empathy and stress physiology with a marked decrease in symptoms of depression and peer-rated aggression.

Through collaboration between a public elementary school, the non-profit Tools for Peace and CHLA, we have implemented a mindfulness curriculum to help kindergarten through 5th-grade students learn healthy coping mechanisms and resilience. Initial findings have shown that students have experienced a positive change in their behavior after mindfulness training, and we expect to see progressive improvement in classroom behaviors and self-regulation as data collection continues.

Benefits and challenges of implementing grief-sensitive schools training in U.S. public schools

Research has shown that the majority of American youth lose someone significant in their life by the time they reach adolescence. While teachers and other school professionals recognize the commonality of bereavement in children, most schools do not offer any training on supporting grieving students. CHLA’s National Center for School Crisis and Bereavement (NCSCB), which specializes in crisis management and bereavement, has been providing training to schools to help staff better care for students.

This project centers around focus groups that IMPACT residents are conducting with school staff who have received training from the NCSCB. The goal is to discuss how they have used the training, what barriers they have encountered and how the COVID-19 pandemic has affected teachers’ ability to support students in times of need.

Educational intervention to improve lactation knowledge and counseling among postpartum nurses in Panama City

This project studies the role of the infant gut microbiome on rotavirus vaccine response by characterizing the differences in breast milk, infant oral and gut microbiome between mother-infant cohorts in Los Angeles and Panama City. Another goal is to gain a better understanding of breastfeeding practices in our mother-infant cohort in Panama City.

After identifying an opportunity for lactation education during the postpartum period prior to discharge, we created a curriculum for nurses as Hospital Santo Tomas in Panama City, which was taught by a certified CHLA lactation consultant. We are now working to make this curriculum a sustainable component of RN training. The aim is to increase nurses’ knowledge of breastfeeding practices and the frequency with which they share this education with their patients.

Implementation of the WHO ETAT curriculum in Quang Tri Provincial Hospital, Vietnam

Many preventable pediatric deaths in hospitals occur within the first 24 hours of admission due to poor identification of illness and delays of treatments. In 2005, the World Health Organization (WHO) created the Emergency Triage Assessment and Treatment (ETAT) curriculum to alleviate this problem by training hospital staff on how to identify patients who need emergent or urgent care.

We have been invited by Quang Tri Provincial Hospital in Vietnam to help implement the WHO ETAT protocol in its emergency department. A focused needs assessment performed in July 2019 found the hospital lacked pediatric-specific triage care and patients were generally seen on a first-come-first-served basis, leading to delayed recognition of serious cases. This IMPACT project is studying patient outcomes before and after the hospital started to use ETAT, with an overarching goal to establish a more sustainable pediatric-specific triage protocol.

Decreasing health care disparities through improved medication history accuracy and timeliness

Patients admitted to CHLA are given the opportunity to complete a patient experience survey, which includes a question about whether they were asked on the first day of their stay to list or review all medications, vitamins and supplements being taken at home. The survey’s results indicate there is room for improvement to ensure all patients are asked this question, particularly those from Spanish-speaking families.

This IMPACT project aims to minimize health care disparities as they relate to the timeliness and quality of gathering a patient’s medical history upon his or her admission to CHLA. Our goal is to improve overall accuracy and completeness of a patient’s medication history, with the hopes that will lead to decreased errors and more equitable health care delivery.

Increasing HEADSS assessments at CHLA

HEADSS (Home, Education, Activities, Drugs, Sex, Suicide) is a confidential screening tool used in adolescent patients to evaluate risk factors such as domestic violence, depression/suicide, sexually transmitted infections and drug use. Although organizations such as the American Academy of Pediatrics advocate for using tools such as HEADSS, as many as 80% of health care encounters do not include such counseling or screening.

In a recent study evaluating the effectiveness of giving HPV vaccines in the inpatient setting at CHLA, only about 51% of adolescents had a HEADSS exam documented by pediatric residents. This IMPACT project analyzes which factors are associated with HEADSS assessment completion and aims to determine if various interventions, such as an automated pop-up in a patient’s electronic medical record or additional conference-time teaching, will increase HEADSS documentation.