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Boston University

Contact:
Nicole Chamoy
nicole.chamoy@gmail.com

Course last offered: November 2008

Page last updated: November 4, 2009

The Spectrum of Physician Advocacy
A Student Faculty Collaborative

Faculty Advisor: Paul O’Bryan, Ph.D. Associate Dean of Student Affairs, BUSM

Student Facilitators
Nicole Chamoy, BUSM II
Melissa Dowd, BUSM II
Carolee Estelle, BUSM II
Lisa Force, BUSM II

Faculty and Guest Facilitators
David Blumenthal, M.D., M.P.P.; Obama Health Adviser and Director, Institute for Health Policy, Massachusetts General Hospital and Partners Health System
Kathleen Conroy, M.D.; Medical Legal Partnership for Children
Sondra Crosby, M.D.; Director of Medical Services, Boston Center for Refugee Health and Human Rights
Jessie M. Gaeta, M.D.;  Staff Physician, Boston Healthcare for the Homeless, Instructor of Medicine, BUSM
Chi-Cheng Huang, M.D.; Assistant Professor of Pediatrics, BUSM
Chen Kenyon, M.D.; Resident, Boston Combined Residency Program in Pediatrics
Megan Sandel, M.D.; Pediatrician, Boston Medical Center, Medical Legal Partnership for Children
Pamela Tames, J.D.; Senior Staff Attorney, Medical Legal Partnership for Children
Robert Witzburg, M.D.; Associate Dean and Director of Admissions, Professor of Medicine, BUSM

Course Advisory Committee
Chen Kenyon, M.D.; Resident, Boston Combined Residency Program in Pediatrics
Paul O’Bryan, Ph.D. Associate Dean of Student Affairs, BUSM
Benjamin Siegel, M.D.; Professor of Pediatrics, BUSM
Rachel Stein, BUSM III
Lie Tjoeng, BUSM III
Mary Ann Wilbur, BUSM IV / M.P.H. candidate
Robert Witzburg, M.D.; Associate Dean and Director of Admissions, Professor of Medicine, BUSM

Course Sponsor:  Public Citizen’s Health Research Group

Course Description
This course will provide a forum for medical students to explore and develop their understanding and perception of:
   1) The unique roles and responsibilities of the physician in society.
   2) The various opportunities for greater involvement in community development, health policy and global health.
   3) Where their respective interests can help define their path in medicine and pursuits beyond medical school.
In addition, students will acquire tangible knowledge and skills to be applied in their clinical training at BUSM and beyond. The class will also foster an environment where students will find inspiration and support from others in their advocacy pursuits.  

The course has the following objectives:

1. To develop a sense of what physician advocacy is and how it can be applied to direct patient care.
     a. To extrapolate the acquisition of knowledge that occurs in medical school into beneficial societal effects and to understand advocacy efforts at a more personal and tangible level.
     b. To recognize that advocacy is linked to the mission of medicine and that some level of patient advocacy is the responsibility of the physician as a medical professional.
     c. To gain a greater awareness of the delicate balance a physician must find in his or her roles as a scientist, a healer, and an advocate.
2. To develop an appreciation of the health disparities that exist at the community, state, national and global level and the consequent need for physicians to act as advocates. 
     a. To recognize the local trends in health outcomes, the sources of disparity, and potential interventions to ameliorate these inequalities.
     b. To translate patient information and community trends into data that can help inform health and public policy making.
     c. To distinguish domestic health agendas from global initiatives as well as appreciate global health disparities in the context of the human rights movement.
3. To encourage the cultivation of individual motivation and preservation of ideals as students proceed through their clinical training
4. To increase awareness of the patient advocacy resources at Boston Medical Center. To recognize the unique approach of our hospital and use it as a model for our future practices.
5. To expose students to a range of opportunities for involvement in advocacy and career paths.

Introduction
Welcome to The Spectrum of Physician Advocacy!  We are excited to journey with you on a two-month-long experience investigating the possibilities for creating systemic health care improvement.  The Spectrum of Physician Advocacy was created three years ago by four fourth year students and will be co-taught this year by four second year students, who participated in the course last year, with a number of accomplished and inspiring BUSM faculty and guest speakers.  Through the interactive sessions, we hope to introduce you to the various responsibilities and opportunities of physicians to advocate for individual patients and to take active roles in greater healthcare debates.  During the course, you will be exposed to a broad range of routine and systemic advocacy topics including medical-legal collaboration, community-oriented health care, translating patient care experience into good health policy, and global health equity. By the end of the two months, we hope that you will: (1) have a better understanding of current topics in health care improvement, (2) understand the unique capital that physicians can contribute to these discussions, (3) have developed a foundation of basic advocacy tools and (4) have made connections with other students and faculty who will provide support and encouragement as you pursue your career as a physician advocate. 

The course will meet a total of eight times (once a week), and will include both seminar/discussion components as well as an advocacy assignment crafted specifically around a health care related issue of importance to you.  This course is an opportunity to deepen your understanding of the interplay between social situations and health and how you as a physician can work to uncouple disadvantages from adverse health outcomes. It is also an opportunity to connect with faculty members who can serve as mentors throughout your medical school careers.

We would like to thank Peter Lurie from Public Citizen for his continuing interest in this class and its mission.  We also thank Bob Witzburg and Ben Siegel for all of their support and guidance throughout the process.  Special thanks to Paul O’Bryan, Phyllis Carr, Liz Gallagher, Maryanne Raposo, and Ana Bediako in the OSA for adopting the course into their department and lives.  Thank you to Sharon Levine for her excitement about expanding the mission of the course and to Catherine Dube and Angela Jackson for their help in doing so.  We offer a final thanks to Chen Kenyon, Rob Chamberlin, Lauren Fiechtner, Rachel Stein, Dan Dworkis, Michelle Katzow, Billy Masch, and Mary Ann Wilbur, whose leadership has been invaluable in the continuing development and success of this course. 

The Spectrum
Session 1: Introduction – The Case for Advocacy
Session 2: Individual Advocacy – the Medical Legal Partnership for Children
Session 3: Community Advocacy – the Social Context of Health
Session 4: Community Advocacy – Immigrant and Refugee Health
Session 5: Global Advocacy – Understanding the Need
Session 6: Global Advocacy – Acting with Responsibility
Session 7: Policy and Advocacy – Healthcare Policy and Universal Access
Session 8: Conclusion – Go Forward, Move Ahead
 
The Schedule
There will be 8 sessions over the course of 10 weeks, with no class during spring break (March 8-12).  Sessions will take place from 4:30-6:30pm on Wednesday evenings, unless otherwise noted.  Sessions will be held in the medical school in L109.
February: 3, 10, 17, 24
March: 17, 31
April: 7, 14

The Advocacy Assignment
Over the next two months, we expect every student, either as an individual or with a group, to undertake a small advocacy assignment. Each week several students will be assigned to give two to three minute presentations on what they did for their assignment.  The assignment should not consume more than two hours of your time and is meant to supplement your learning. Examples of previous student projects are listed below.

Faculty and Guest Facilitator Biographies:
David Blumenthal, M.D., M.P.P. is Director, Institute for Health Policy and Physician at The Massachusetts General Hospital/Partners HealthCare System in Boston, Massachusetts.  He serves on several editorial boards, including the American Journal of Medicine and Journal of Health Politics, Policy and Law. He is also a National Correspondent for The New England Journal of Medicine. He serves on advisory committees to the National Academy of Sciences, the Institute of Medicine, the National Academy of Social Insurance, the Open Society Institute and other foundations and is the founding chairman of Academy Health. He is a Senior Advisor to the Obama campaign in health policy. His research interests include the dissemination of health information technology, quality management in health care, the determinants of physician behavior, access to health services, and the extent and consequences of academic-industrial relationships in the health sciences.

Kathleen Conroy, M.D. is a graduate of the Children’s Hospital/BMC combined residency program in pediatrics and is currently a Fellow in General Pediatrics at Boston University.  Her research interests include how meeting a patient’s basic social needs can impact health outcomes.

Jessie M. Gaeta, M.D. is on staff at the Boston Health Care for the Homeless Program and is a faculty member at Boston University Medical Center where she regularly attends on the inpatient medical ward that is largely responsible for the care of the sickest homeless people in Boston. Her clinical experience with homeless patients has led to her interest in affecting housing policy as a strategy to improve the chronic illnesses and lives of her patients.

Chi-Cheng Huang M.D. graduated from Harvard Medical School in 1998.  He is the Medical Director of Inpatient Pediatrics and Director of the Pediatric Global Health Initiative at Boston Medical Center.  He has spent the last fifteen years advocating for the lives of street children in developing countries; helped found Casa Bernabe, a home for Bolivian street children, in 2001; and founded the non-profit organization Bolivian Street Children Project.  He lives with his wife, Kristin, and their three daughters.  

Pamela Tames J.D. is an attorney who serves as National Legal Director of Education and Training with the Medical-Legal Partnership for Children in Boston.  Ms. Tames directs the legal advocacy education and training initiatives for pediatricians and allied health care providers, private law firm attorneys, and graduate and undergraduate student interns.  Ms. Tames has spearheaded MLPC’s clinical work in terms of education and school-related matters, and for several years in terms of health services, health insurance, and income supports for families whose children have disabilities or chronic illness.  In partnership with physicians and other allied health providers, Ms. Tames has spearheaded successful MLPC policy initiatives.  Her experience in the education policy arena was formally recognized in 2007 when she was awarded the prestigious Schott Fellowship in Early Education and Care.

Megan Sandel M.D. is the National Medical Director with the Medical-Legal for Children in Boston and was the first medical director of the Family Advocacy Program in 1998.  Dr. Sandel is an assistant professor of Pediatrics at the Boston University School of Medicine, the Director of Pediatric Healthcare for the Homeless at Boston Medical Center, and a nationally recognized expert on housing and child health.  She served as a general academic fellow at Boston Medical Center with a concentration in environmental health in children, earning a Masters of Public Health with a dual concentration in environmental health and epidemiology and biostatistics in 2002.  In 1998, she published with other doctors at Boston Medical Center, the DOC4Kids report, a national report on how housing affected child health.  In 2000, she was a co-Principal Investigator of the Boston Healthy Homes Partnership, a grant from Department of Housing and Urban Development to the Boston Public Health Commission. She is a founding member of the Asthma Regional Council of New England.

Robert Witzburg, M.D. is the Associate Dean of Admissions and Professor of Medicine and Health Services at Boston University School of Medicine.  He attended Boston University School of Medicine. He completed his residency in internal medicine at Boston City Hospital, where he was also Chief Resident.  His passion for medicine, for helping people, and for BU is contagious, and he is greatly admired by his students, colleagues, and patients.

The Spectrum of Physician Advocacy
Session 1: An Introduction to Physician Advocacy
Carolee Estelle

Faculty Mentor: Robert Witzburg, M.D.

Learning Objectives: 
By the end of the session, students should be able to:

1. Provide a broad definition of what advocacy is, and what role it can play in the career of a physician
2. Identify situations in which advocacy is a tool that can be employed to achieve medical aims

Outline for Session:
I. Ice Breakers

II. Introduction to the Spectrum of Physician Advocacy Course
   a. Pass Out Syllabus
   b. Class Requirements
   c. Advocacy Project
   d. Logistical Issues
   e. Meet the Student Facilitators

III. Advocacy – Context, Culture, and History
   a. What is advocacy?
   b. Who can be an advocate?
   c. What role can advocacy play for physicians?
   d. How has the concept of advocacy evolved?

IV. Advocacy – A Personal Consideration (Small Group Activity)
  a. Why are we here in the SPA course?
  b. Why medicine, why advocacy?
  c. Is advocacy necessary?  How important is it?
  d. In what ways can advocacy address the limitations of medicine?

V. The Life of an Advocate (Bob Witzburg)

VI. Q&A

VII. Wrap up
 
Required Reading
“The Challenges of Patient Advocacy on the Wards: Reflections from a Third-Year Medical Student”
Current Surgery, Volume 63, Issue 5, September-October 2006, Pages 357-358
Rose Kakoza III

The Spectrum of Physician Advocacy
Session 2: Individual Advocacy - the Medical Legal Partnership for Children
Melissa Dowd

Faculty Facilitators
Megan Sandel, M.D. and Pamela Tames, J.D.

Learning Objectives
By the end of the session, students should be able to:
1) See how physicians can advocate for patients on an individual level  
2) Gain a greater awareness of the resources for patients at BMC
3) Recognize how an individual’s circumstances can influence their health and health care delivery

Session Outline
I. Introduction
II.   The social context of health
   A)  Introduction to the social context of disease
   1)  “…economic and educational policies that are targeted at children’s well-being are implicitly health policies with effects that reach far into the adult life course.”  -Mark Hayward and Bridget Gorman
III.  Brief introduction to the MLPC: 
 Direct advocacy on specific client problems with health insurance, immigration, housing, nutrition, education, and violence
IV.  The MLPC Speakers: Kathleen Conroy, MD and Johanna Flacks, JD
  A)  Overview:
  • How it works
  • How it effects change for children
B)  Becoming involved in advocacy
C)  Advocacy and daily life
D)  Barriers and solutions
E)  Success stories
F)  MLPC on a local and national level
G) Questions
 V.   Case-based small group activity
1)  What else would you want to know about your patient’s social history and?
2) Why are these things important to know?
3)  What sort of social circumstances might be exerting influences on your patient’s health?
4)  How do you address these issues with your patient?
5)  Brainstorm: in what ways can you affect change in the social circumstances identified in question three? 

Required Reading
Zuckerman, B, Sandel, M, Smith L and Lawton, E. Why Pediatricians need Lawyers to Keep Children Healthy. Pediatrics. 2004: 114(1); 224-228.

Kenyon, C, Sandel, M, Silverstein, M, Shakir, A, Zuckerman, B.  Revisiting the Social History for Child Health.  PEDIATRICS Vol. 120 No. 3 September 2007, pp. e734-e738 (doi:10.1542/peds.2006-2495).

Optional Readings 
Wise, PH. The Transformation of Child Health in the United States. Health Affairs. 2004: 23(5); 9-25.

The Spectrum of Physician Advocacy
Session 3: Community Advocacy I - The Social Context of Health
Nicole Chamoy

Faculty Facilitator
Kathleen Conroy, M.D.

Learning Objectives
By the end of the session, students should be able to:
1. Provide examples of different social factors that affect health.
2. Identify situations in which a social problem is affecting the health of a patient and must be remedied before health can improve.
3. Be familiar with some of the programs/resources at BMC that address specific social determinants of health.

Session Outline
I. “Social Medicine”
  a. Field of medicine that seeks to understand how social and economic conditions impact health, disease and the practice of medicine
  b. Rudolf Virchow, “Father of Social Medicine”:
  - “Medicine is a social science in its very bone and marrow.” 
  - “Politics is nothing more than medicine on a grand scale.”

II. The Social Determinants of Health (WHO)
  a. The Social Gradient: socioeconomic status is directly related to health status
  b. Stress: anxiety, low self-esteem, insecurity, social isolation, and feeling a lack of control over one’s life negatively impacts health outcomes
  c. Early Life: slow growth and poor emotional support raise the lifetime risk of poor physical health and reduce physical, cognitive, and emotional functioning in adulthood
  d. Social Exclusion: poverty, racism, discrimination, hostility and unemployment are damaging to both physical and emotional health
  e. Work: stress at work increases the risk of disease
  f. Unemployment: “Job security increases health, well-being, and job satisfaction” (WHO 2003: 20)
  g. Social Support: “Friendship, good social relations and strong supportive networks improve health at home, at work and in the community.” (WHO 2003: 22)
  h. Addiction: Substance abuse has a negative impact on health and must be addressed from both a social and biological perspective
  i. Food: lack of adequate nutrition as well as excess intake of food directly and negatively impacts health
  j. Transport: both mode of transportation and lack thereof affect health outcomes

III. BMC Resources that address the social determinants of health
  a. Medical Legal Partnership for Children (MLPC)
  b. Reach Out and Read
  c. Project Health
  d. Child Witness to Violence
  e. Good Grief
  f. The SPARK Center
  g. Boston Center for Refugee Health and Human Rights
  h. Child Protection Team
  i. Elders Living at Home Program
  j. Haitian Health Institute

Required Reading
Marmot M. Social determinants of health inequalities. Lancet 365:1099-1104, 2005.

The Spectrum of Physician Advocacy
Session 4: Community Advocacy II – Immigrant and Refugee Health
Lisa Force

Faculty Facilitator
Sondra Crosby, M.D.

Learning Objectives
By the end of this session students should be able to:

1. Identify specific social factors that affect the health of immigrant populations.
2. Understand the Community Health Center model and how CHCs are serving immigrants in Boston.
3. Be familiar with some of the resources at BMC available to immigrants and refugees.

Session Outline
I. Social Factors that affect the health of immigrants
   a. Health insurance: Immigrants, both naturalized citizens and non-citizens, are more likely to be uninsured or underinsured
   b. Access to health care: Immigrants are less likely to use primary and preventive medical services, hospital services, emergency medical services and dental care than native born citizens
   c. Language: Limited English proficiency is a risk factor for difficulty understanding medical situations and problems with medications; the use of translators mitigates the risk but also raises other issues
   d. Cultural competency: Patients hold unique concepts of health and sickness, medicine, and the doctor-patient relationship
   e. Conditions in country of origin: It is important to know the patient’s previous access to health care, exposure to infectious disease, nutritional status, and the political situation and risk for torture in their home country
   f. Mental Health: As with all patients, physicians should be on the look-out for the presence of depression in their immigrant patients

II. Community Health Centers – a safety net for Boston’s immigrant population
   a. Community health centers (CHCs) are local, non-profit health care providers serving low income and medically underserved communities
   b. CHCs provide primary care and preventive services regardless of insurance status or ability to pay
   c. CHCs provide services in a linguistically and culturally appropriate setting

III. Resources at BMC for Immigrants – A “Safety Net Hospital”

Required Reading
Crosby S, Apovian C and M Grodin. Hunger Strikes, Force-Feeding, and Physicians’ Responsibilities. JAMA. 2007: 298(5): 563-566.

Crosby S. Seeking Asylum from Torture: A Doctor’s View. Ann Intern Med. 2007;147:431.

Garcés I, Scarinci I and L Harrison. An examination of sociocultural factors associated with health and health care seeking among latina immigrants. Journal of Immigrant and Minority Health. 2006: 8(4): 377-385.

The Spectrum of Physician Advocacy
Session 5: Global Advocacy – Understanding the Need
Lisa Force

Faculty Facilitator 
Chi-Cheng Huang, M.D.

Learning Objectives
1) Better understand and explain our global health reality, identify global health disparities
2) See global health inequities as a primary health challenge of the 21st century
3) Better understand the link between global health and economic development
4) Explore the roles of U.S. citizens, in particular students and physicians, as well as the United States government and companies in global health issues

Session Outline
I. Advocacy Project Presentations

II. Chi-Cheng Huang, M.D.
- Overview of current issues in global health
- Building the Bolivian Street Children Project
- Integrating international advocacy into a career

III. Group discussion of global advocacy
 - Reflections on class so far:
   • How is global advocacy similar or different from local advocacy
   • What have we learned so far that is applicable globally? What isn’t?
   • How far does a physician’s responsibility extend (back to first class)?
   • Reconciling health problems in our own neighborhoods with health problems across the world. Where should we focus our efforts and resources?

 - Why should we care?
  • It doesn’t affect me – How does inequity affect us living here?
  • We already give enough – Statistics on foreign aid and finance
  • We don’t have the money – What does the US spend money on? How do we change what the US spends money on?
  • It doesn’t make a difference – Can we be effective as global advocates?

Required readings
Bridge Over Sewer System.  Passage from Dr. Huang’s book.

Goston LO.  Why Rich Countries Should Care About the World’s Least Healthy People.  Journal of the American Medical Association, Volume 298(1): 89-92, 2007.

Shaywitz DA, Ausiello DA.  Global health: A chance for Western physicians to give – and receive.  American Journal of Medicine.  Volume 113: 353-357, September 2002.

Optional Readings
Marmot M on behalf of the Commission on Social Determinants of Health.  Achieving Health Equity: From Root Causes to Fair Outcomes.  The Lancet, Volume 370: 1153-1163, 2007.

Labonte R, Schrecker T, and Gupta AS.  A Global Health Equity Agenda for the G8 Summit.  British Medical Journal, Volume 330: 533-536, 2005.

Explore Bolivian Street Children Project’s website:  <www.kayachildren.org>

The Spectrum of Physician Advocacy
Session 6: Global Health – Acting with Responsibility
Melissa Dowd

Student Facilitators 
Panel of BUSM students who have volunteered abroad in a medical capacity

Learning Objectives
1) Further explore specific examples of global health advocacy, both direct and indirect.
2) Critically evaluate our own views of the developing world.
3) Competently discuss ethical and cultural considerations and the challenges of working in resource poor settings.

Session Outline
I. Advocacy Project Presentations

II. Discussion of readings in small groups
 - What are the pros and cons of volunteering abroad in a medical capacity?
 - What are ways in which we can improve the system?
 - How short is too short-term?  Does one have to live abroad to serve abroad?

III. Introduction of panel
 - Descriptions of experiences abroad, perspectives on global health
 - What they would like to have done differently in their own experience
- What they would like to change about the way in which Americans participate in global medicine

IV. Group Discussion
- Do members of the class have any experiences abroad? How do their experiences compare to these?
- What is one’s role as a foreign volunteer/aid worker/physician in a foreign community?
- How does one integrate their work into the fabric of the community and pre-existing infrastructure?

Required readings
Roberts, M. A Piece of my mind. Duffle bag medicine. JAMA. 2006; 295(13):1491-2

Hurt, A. Altruism of tourism, why med students go abroad, and who benefits? The New Physician. 2007; 12-18

Optional readings
Benatar SR.  Reflections and recommendations on research ethics in developing countries. Social Science & Medicine 54 (2002)1131–1141.

Darfur, Assault on Survival: A call for security, justice, and restitution. Physicians for Human Rights. 2006. Executive Summary, pages 1-5.

The Spectrum of Physician Advocacy
Session 7: Policy and Advocacy: Upcoming Changes in the Health Care System
Nicole Chamoy

Faculty Mentor:
David Blumenthal, M.D., M.P.P.

Learning Objectives:
By the end of this session, students should be able to:
1. Universal health care policy attempts in the U.S and their effects on modern day health policy.
2. Understand the motivations behind health care policy debate—what are the advantages and obstacles facing the implementation of universal health care in the United States.
3. Recognize the key players in a health care policy debate.
4. Understand the upcoming changes in national health care; recognize sustainability of such a system, and the direction that health policy is heading.

Outline for session:
I. Introduction
II. Examination of Health Care Policy
  i. What are some of the reasons that the United States does not have a national health care system?
  ii. How do other countries negotiate the costs of universal health care with a national system of government?
  iii. What does the role of preventative medicine have in such a program?
  iv. What are the characteristics that you would like to see in a universal health care system?
1. Are these characteristics evident in the new Obama health care plan?
2. What is the sustainability of such a program (refer to Massachusetts health care plan and its sustainability)
  v. How can physicians make a difference?
III. Speaker—Dr. David Blumenthal
IV. Conclusion
  i. Questions?

Required Reading
Barack Obama and Joe Biden’s Plan to Lower Health Care Costs and Ensure Affordable, Accessible, Health Coverage for All.

Chua, Kao-Ping. Overview of the US Health Care System.  2006 February 10.

The Spectrum of Physician Advocacy
Session 8: Going Forward From Here
Carolee Estelle

Faculty Mentor: Jesse Gaeta, M.D.

Learning Objectives:
By the end of the session, students should be able to:

1. Explain the various avenues that students and physicians can use to be advocates
2. Identify some of the various resources available to advocates in general, and here at BMC
3. Feel comfortable going forward with their careers armed with the foundations needed to explore advocacy work

Outline for Session:
I. Project Presentations

II. Introduction

III. Healthcare for the Homeless, & The Nuts & Bolts of Advocacy (Jesse Gaeta)

IV. Where We Are Today & Looking Toward the Future (Small Group Activity)
  a. How do we feel about advocacy now as compared to the start of the course?
  b. Are we comfortable locating and utilizing advocacy resources?
     c. In what aspects of advocacy do we see ourselves engaged in the future?
     d. How do we keep our drive to do advocacy strong?

V. Closing Remarks
e. What to keep in mind as we move forward
f. How do we keep going with advocacy?
g. Future course leaders

VI. Wrap up & Course Evaluations

Boston Medical Center Resources:

• Boston Center for Refugee Health and Human Rights
• Boston Landscape Project (examining culturally and religiously grounded complementary and alternative medicine in Boston)
• The Breastfeeding Center
• Child Life Program (helping children and families manage the stresses associated with hospitalization and illness)
• Child Protection Team (identification and prevention of child abuse)
• Child Witness to Violence (counseling, advocacy, and outreach to children who are bystanders to community and domestic violence)
• Elders Living At Home Program (temporary and emergency housing and case management services to elderly men and women who are at risk of becoming homeless)
• Global Child Health Initiative (providing residents with knowledge and opportunities in global child health)
• The Good Grief Program (training, consultation, and crisis intervention in the area of children's bereavement)
• Haitian Health Institute (culturally and linguistically sensitive care for the Boston Haitian community)
• Healthy Steps (national initiative that focuses on the importance of the first three years of life)
• Homeless Clinic
• Koh Memorial Health Center (cross-cultural care in the delivery of care to Korean Americans)
• Massachusetts Center for SIDS (counseling and information to families whose infants have died of SIDS)
• Mattapan Adult Day Health Program (support system to help families with decisions about the care of their loved ones)
• Pain Free Pediatrics (program to help minimize pain and discomfort on the care of pediatric patients)
• Project Health (college students providing public health interventions)
• Reach Out And Read (non-profit organization that promotes early literacy by giving new books to children and advice to parents about the importance of reading)
• The SPARK (Supporting Parents and Resilient Kids) Center (formerly the Children’s AIDS Program)

more resources

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