1. Taking Action to Address Child Poverty
APA Poverty Curriculum
Module 4

2. Goal By the end of this module, learners will be prepared to:
Communicate the effect of policy on child health

3. Specific Objectives
Outline the priorities of child advocacy organizations related to child poverty
Discuss the unique voice and power that pediatricians and child health providers possess as advocates for policy
Tailor a message to communicate effectively with different stakeholders about child poverty
NOT SURE ABOUT OJB #3 HERE – “TRANSLATE” HMMM. SEEMS SIMILAR TO #4. JUST DELETE #3?

4. Suggested Time Allocation
Roadmap
Topic
Activities
Suggested Time Allocation
Poverty Issues
Pair share
10 Minutes
Poverty Policy
Pair Share
Policies and Advocacy Organizations
Large group discussion
Physician advocate
Crafting your message
Individual work and then large group share
20 Minutes
NEED TO UPDATE TO REFLECT NEW REALITY

5. Poverty Issues & Pair Share
The AAP policy on Poverty and Child Health (2016) recommends that pediatricians assess the financial vulnerability of their patients’ families in clinic
Thinking over your clinical experiences in the last month, what poverty-related health issues would you have heard if you asked parents,
“Do you ever have trouble making ends meet?”
Turn to the person next to you and discuss:
What are 2-3 issues you think parents would say?
What could you do for patients in clinic with each issue?
*Goal 1, Objective 1– Laying the groundwork for the unique pediatrician voice by mining clinical experience.
- In 2016, the AAP released a statement that the AAP is committed to reducing and ultimately eliminating child poverty in the US. AAP recommends that pediatricians assess the financial stability of families, linking families with resources, and coordinating care with community partners.
- Allow residents to turn to their neighbors to discuss. After about 5-7 minutes of discussion, ask for volunteers to share their discussion with the large group.

6. Poverty Policy & Pair Share
Many poverty-related health issues can’t be fixed in clinic. They call for upstream policy solutions
In your pairs consider: How could you take action on one of the most common poverty-related health issue, food insecurity?
…through a policy change in your clinic or hospital?
…through a policy change in your state?
…through a policy change nationwide?
*NO SPECIFIC GOAL HERE, JUST STARTING TO CONNECT CLINICAL PRESENTATIONS TO POLICY ROOTS. SHOULD IT BE A GOAL? HE HAD IT BEFORE AS GOAL1 OBJECTIVE 3 – EVALUATE A CURRENTLY PORPOSED US LEGISLATION THAT COULD + OR _ AFFECT CHILD POVERTY” BUT I DON’T SEE HOW THIS EXERCISE MEETS THAT GOAL. I DO LIKE THE THINKING, GETTING THEM GOING IN THIS BIG PICTURE DIRECTION.
Facilitators:
- Allow residents to turn to their neighbors to discuss. After about 3 minutes of discussion, ask for volunteers to share their discussion with the large group.

7. Choose a Poverty-Related Policy
The AAP Federal Advocacy website is a place to find and learn about policies related to child poverty
*GOAL 1 OBJECTIVE 1
The AAP is the organization that most closely represents pediatricians at the state and national levels.
Either go to the website as a group or ask residents to each navigate to the AAP Federal Advocacy website to review the AAP’s up to date policy assessment of food insecurity
Example Poverty-Related Issues from the Case for Faculty/Facilitator Guide:
Food Insecurity –Food insecurity is an area where multiple policies (such as clinic level screening, community-health system referral partnerships, local regulations regarding food bank donations from restaurants, state SNAP eligibility, and federal food bills) are ripe for advocacy to improve the health of children in poverty.
DIG DEEPER:
(if time permits can have similar discussion around health insurance coverage)
Health Insurance for Poor Children –Low reimbursement for Medicaid patients relative to private insurance has led to widespread disparities in access to care, an particularly specialty care, for children with Medicaid insurance, which can lead to delays in care and worse health outcomes. Lack of insurance options for undocumented children in most of the country present even greater barriers to accessing care. Opportunities abound at the local, state, and national levels to advocate for policies that promote parity for providers that accept Medicaid and policies that ensure equal access to care for children with public insurance.

8. Child Advocacy Organizations
Consider the priorities and roles of these organizations when looking for allies in action on child poverty policies
Get to know their priorities and partner with them
*GOAL 1 OBJECTIVE 1
Beyond the AAP there are many other child advocacy organizations, both at the state and federal levels.
Here are a few examples of national child advocacy organizations.
For Faculty/Facilitator Guide – Facilitators Should Share with Learners These Summary Descriptions of Child Advocacy Organizations’ Priorities and Roles in Improving the Well Being of Poor Children [WE MAY NEED TO DEVELOP A HANDOUT SUMMARIZING THESE IN MORE DETAIL]:
First Focus
A bipartisan advocacy organization dedicated to making children and families the priority in federal policy and budget decisions.
National scope
A non-profit child advocacy organization that has worked relentlessly for more than 40 years to ensure a level playing field for all children. We champion policies and programs that lift children out of poverty; protect them from abuse and neglect; and ensure their access to health care, quality education and a moral and spiritual foundation. Supported by foundation and corporate grants and individual donations, CDF advocates nationwide on behalf of children to ensure children are always a priority.
The Children's Defense Fund (CDF)
National scope with some state chapters
Children Now is the only umbrella children’s organization working to improve children’s health, education and overall well-being.
Children Now
State level: Focus is in CA
Stand for Children –
For 20 years, we have advocated for better and equal education standards for all children by utilizing a strong three-pillared approach: Parents, Politics, and Policy.
State level: In eleven states: AZ, CO, IL, IN, LA, MA, OK, OR, TN TX, WA
Too Small to Fail
Too Small to Fail aims to help parents and businesses take meaningful actions to improve the health and well-being of children ages zero to five, so that more of America’s children are prepared to succeed in the 21st century.
The collective work of the Alliance involves keeping Five Promises to children and youth that form the conditions they need to achieve adult success.
America’s Promise Alliance
National scope – an alliance of 360 national partner organizations
ReadyNation is the preeminent business leader organization working to strengthen business through better policies for children and youth. Our members educate policymakers and the public about effective investments that will help business compete in today’s global marketplace, build a foundation for lasting economic security, and help children get on the right track to succeed in school and in life members educate policymakers and the public to advance effective policies and programs that improve business competitiveness by helping children get a good start in life.
ReadyNation
National scope with some state chapters.
NCCP is one of the nation’s leading public policy centers dedicated to promoting the economic security, health, and well-being of America’s low-income families and children. NCCP uses research to inform policy and practice with the goal of ensuring positive outcomes for the next generation. We promote family-oriented solutions at the state and national levels. Founded in 1989 as a division of the Mailman School of Public Health at Columbia University.
National Center for Children in Poverty (NCCP)
Docs for Tots
Docs for Tots is a non-profit, non-partisan organization led by pediatricians to promote practices, policies, and investments that will enable young children to thrive. Docs for Tots creates linkages between doctors, policymakers, early childhood practitioners, and other stakeholders to ensure that children grow up healthy. Their focus is on the youngest children and their families, from prenatal to children age five. One of their five priority areas is addressing the impacts of poverty.
Ounce of Prevention
The Ounce of Prevention Fund gives children in poverty the best chance for success in school and in life by advocating for and providing the highest-quality care and education from birth to age five. The organization serves children and families in Illinois through a network of home visiting programs and trains community-based early childhood professionals. They partner with advocacy organizations in 17 states and Washington, DC to build capacity to advance policy change and increase pubic investments in effective birth-to-five programs. They also design and develop models, curricula, education materials and other programs that help prevent the academic achievement gap and the social problems it can create.

9. Taking action :the unique voice of the physician advocate
What unique features do physicians bring to advocacy?
Goal 1: Obj 2

10. Example: Taking Action on a Poverty-Related Issue
*Goal 1, Objective 2 – Example of effective pediatrician voice.
Activity for Facilitators:
Now that the learners have considered how the poverty-related issue of food insecurity requires “upstream change”, the logical next question is “How can we create change on these issues as pediatricians?”
This video is meant to offer learners an example of how pediatricians can effectively advocate on behalf of economically marginalized children and communities.
Watch this short video twice – first just watch it. The second time ask the learners to consider how this pediatrician effectively communicates her message about a poverty-related issue that affected her patients and community.

11. The Pediatrician’s Voice
In the video you just watched,
Overall, what was effective about the pediatrician’s messaging?
What knowledge made her voice as a pediatrician particularly effective?
*GOAL 1, OBJECTIVE 2: ON THE NOSE
Activity for Facilitators:
There are a few things that make pediatricians unique advocates.
Access to patients
Knowledge about child health
Ability to bear witness, tell stories to decision makers
We posses a powerful, respected voice.
Ask the learners, “Overall, What was effective about the pediatrician’s messaging in this example video?”
“What knowledge made her voice as a pediatrician uniquely effective?”
“What about her access to kids made her a unique child advocate?”
“Do you think she is uniquely respected in her community? Why or why not?”
Summarize the learners’ responses and be sure to include and emphasize the following points if they are not brought up by learners”
Data driven
Based on first-hand experiences with patients and communities- physicians can bear witness to marginalized populations
Clear answers without a political agenda
Trusted expertise and credibility

12. Your Voice as a Pediatrician
What is uniquely powerful about the voice of pediatricians and clinicians regarding poverty?
We have professional credibility
We focus on data and evidence
We have consistent contact with young children disenfranchised by society
We are witness to the struggles of our families
*GOAL 1 OBJECTIVE 2
We can all advocate as citizens.
How are we unique when we invoke our professional role?
Review slide

13. Taking Action Crafting your message
Goal 1; Obj 3
For the final portion of the module the learners will tailor a message to communicate effectively with decision makers

14. Analyzing Food Insecurity for Advocacy
Let’s think back to food insecurity. It can be addressed at many levels (the clinic or hospital, your health system, community, state, or national)
Think back over your patient experiences who have been uninsured or food insecure.
Look through the websites of prominent children’s advocacy organizations, always start with AAP
*GOAL 1 OBJECTIVE 3
Learners should utilize the AAP Federal Advocacy Pages to choose a topic for advocacy
Example Poverty-Related Policies from the Case for Faculty/Facilitator Guide:
Food Insecurity – Policies that may be chosen regarding this issue include clinic level food insecurity screening policies, referring families to food banks and SNAP enrollment sites, state SNAP eligibility regulations, and federal food bills addressing SNAP, the school based free and reduced cost breakfast and lunch programs, etc.
Review the AAP website, and others that interest the residents, for the work on food insecurity.
DIG DEEPER:
Health Insurance for Poor Children – Policy and advocacy opportunities regarding pay parity for insurance for poor children and equal access to specialty services abound at the local, state, and national levels. Check with your local clinic’s administrators, local/state/national child advocacy organizations (see next slide), and the AAP Federal Advocacy website for ideas regarding policies to target, since the specific policies will likely change frequently.
Can discuss Medicaid ACOs – there have been individual level difficulty associated with this policy change. Typical issues that have been faced by our patients are reassignment to a different medial home, prescription coverage gaps, helping our patients to choose the MCO that is in line with their medical home, and the difficulty of doing this.

15. Writing your Brief Statement
Opening – Two Sentences
State your title as a health professional
Get right to food insecurity (FI) and your policy solution
Body of the Statement – three to four sentences
Explain food insecurity
Connect FI to child health
Tell a recent patient story
Conclusion – Two Sentences
Deliver your “ask”
Look at the AAP’s Federal Advocacy webpage, and find the Child Nutrition section, there you will learn about the AAP’s resources to address food insecurity through advocacy
*GOAL 1 OBJECTIVE 3 – THE DELIVERABLE MESSAGE

16. Anatomy of a 1-page letter
Name/Issue/Position
Honorable Governor Smith:
My name is Jane Jones and I am a pediatrician practicing at Apple Valley Children’s Hospital. I applaud and
appreciate your past efforts to support funding for ‘Food For All’, our state’s food stamp program. I strongly urge you to keep Food For All as a high priority by fully funding it in your upcoming budget revision.
‘Food For All’ helps the working poor feed their families. In 2015, more than 40% of the patients in our clinic
reported not having enough money at the end of the month to buy food for their families. When families do
not have enough food their children have worse health and struggle more in school. As a pediatrician, I have
many examples of this difficult situation. Just last month I recall seeing a toddler for a check up and the mother reported they did not have enough money to pay for both rent and food. She said she was giving her child water instead of milk which we recommend for healthy tooth and bone development. I was able to connect her to ‘Food For All’ and with their support I am hopeful that the toddler is now getting the calories and nutrients she needs to thrive.
For the health of our state’s children, I urge you to ensure continued funding for ‘Food For All’. Again, thank
you for your continued support. Please do not hesitate to call me for any questions.
Sincerely,
[Your Name, MD/Medical Student]
[Your Hospital or Clinic]
Stats
Here is an example of the structure of an advocacy letter.
This is the same “formula” that can be used for in person testifying on a bill or when meeting with a legislator: name/issue, statistics, personal story, and “the ask”.
Now everyone (in groups or individually) should draft a short advocacy letter addressing food insecurity.
If time permits the group can share and provide feedback on the letter.
Personal Story
Request

17. Connecting the Dots Thinking about food insecurity, how would
reducing it affect health?
How could reducing food insecurity by changing a policy reduce poverty?
How are pediatricians uniquely suited to reduce food insecurity?
*GOAL 1 OBJECTIVE 1, 2 and 3
To sum things up review these questions.
For Facilitator Guide/Case Supplement:
There are many impacts of food insecurity on child health (ref: Boston Children’s site, Deborah Spivek’s work). Food insecurity and its resulting hunger contribute to failure to thrive, to school failure, to….
Reducing food insecurity for a family by enabling them to get food thru SNAP or the free and reduced lunch program at school means the family has to spend less of their budget on food. This allows them to be able to use their limited income on housing/rent, health care, school expenses, etc. Nationally we know that SNAP lifts XX% of families out of poverty (web site).
Pediatricians are uniquely suited to reduce food insecuirty thru their access to nearly all children in the community, allowing us access to reach the most difficult to reach and otherwise disengaged families, many of whom are most at risk for food insecurity and hunger. We can bear witness to their stories in testimony. We enjoy a powerful voice when we advocate for our families. We have access to local data (our clinic data) and knowledge about the impacts of food insecurity.

18. Source: AAP Advocacy Guide, Page 80
Crafting Letter
Remember
State you are a pediatrician and constituent
Personalize your letter to your stakeholders
Use the news
Keep it local
Keep it brief
Source: AAP Advocacy Guide, Page 80
This slide is for groups that have time left over for their taking action module and wish to translate their brief messages into a written letter or .
Key elements of the approach:
State you are a pediatrician and constituent – establish your credibility and the power of your voice
Personalize your letter to your stakeholders – tailoring letters to stakeholders can take many forms, including using different levels of data (local, state, or federal) depending on the policymaker of interest, understanding the motivations and incentives of your stakeholders and aligning your messaging with them, or knowing where you have areas of agreement with stakeholders that can be the foundation for productive partnership.
Use the news – a key feature of effective letters is that they are timely, and timing your letter to correspond with issues grabbing current headlines is a great way to get attention and drive change.
Keep it pertinent – stakeholders who are at the local level are focused on their area, not what’s going on elsewhere. Don’t lose their attention by talking about issues they don’t care about or can’t control.
Keep it brief – Long letters run the risk of burying the impact of your message. Don’t bore your reader with a long diatribe. Get to the point.
IMPORTANT TIP!
If you are doing this work at work, as a part of a hospital or practice, you CANNOT speak for them. You CAN either speak for yourself or reach out to the Government Relations department at your institution and work with them to speak in concert with your institution.

19. Everyone has 5 minutes
Sign up for AAP and other child advocacy groups alerts
Become an AAP Key Contact
Subscribe to a trusted news site, skim it each day
Call a legislator and leave a quick message
Wear your message with a badge or pin
Share your voice for kids through social media
Write letter to the editor
Vote!

20. Dig deeper
Link to AAP for all modules
Case study on Wisconsin “Early Brain Resolution”;
After finishing your letter, send it to others in your intended audience or adapt it for the Op-Ed page of your local paper.

21. Pre-work
Facilitators may learners approximately one week ahead of this module and ask them to:
Read the AAP “Poverty and Child Health in the United States” Policy Statement:
Consider child poverty-related health issues and their policy foundations to engage through advocacy

22. Resources Identification of poverty-related issues for advocacy
AAP Federal Legislative Advocacy:
AAP State Legislative Advocacy:
AAP Community Advocacy:
Children’s Defense Fund:

23. Acknowledgements
The APA Task Force on Child Poverty Education Committee Co-Chairs - Lisa Chamberlain, MD, MPH, FAAP & Melissa Klein, MD, MEd, FAAP
Workgroup Leaders - Brian Lurie MD MPH and Adam Schickedanz MD
Content Contributors - Susan Bostwick MD, MBA, Lee Ford-Jones MD, Ambica Nakhasi, MD, Amanda Osta MD, and Barry Solomon MD MPH
Facilitator Guide developer – Melissa Ruiz, MD