JeffSTARS

Program Description

The Jefferson Service Training in Advocacy for Residents and Students (JeffSTARS) program is designed to move young physicians beyond the medical model and the walls of the health system to improve our understanding of struggles that patients face. JeffSTARS emphasizes the importance of social determinants of health and health behaviors as influenced by the socioecological model. The program directly impacts students, community organizations, doctors and patients. With over 22 community partner organizations, JeffSTARS has developed a network of experts and resources to help families with challenging health issues where advocacy plays an important role. Over the past nine years, JeffSTARS has impacted approximately 1980 (220/year) medical students and residents with approximately 90 (10/year) participating in month-long, experiences working side-by-side with partner organizations. Monthly Advocacy Journal Clubs, weekly Advocacy Cafe’s, and weekly engagements with partner organizations address complex topics that impact child health and are central to behavioral health, including trauma informed care, toxic stress, adverse childhood experiences (ACEs), LGBTQ issues, juvenile justice, media violence, depression, and substance use disorders. JeffSTARS also provides opportunities throughout the year for young physicians to advocate for child health with state and federal policy makers. Stigma, isolation, and lack of resources are common themes addressed.

Creativity

JeffSTARS, supported by leaders at the Sidney Kimmel Medical College of Thomas Jefferson University (TJU) and Nemours, creatively integrates concepts into medical education, impacting the way doctors think and cultivating young physicians to incorporate behavioral health concepts into patient care and health policy. With an opportunity to work directly with health advocates, young doctors use newly added “black bag” tools to “a”dvocate for their patients one-on-one and to “A”dvocate for policy changes on a community level with legislators. Our network of partner organizations, whose common mission is to help and advocate for children, works collaboratively and benefits from shared resources. Focusing on health advocacy, experts in non-medical disciplines –including social work, law, government and education — disseminate important patient resources and train clinicians. With a learner-driven approach, the curriculum focuses on current events and immediate behavioral health concerns, such as the opioid crisis and adolescent depression and suicide.

Leadership

JeffSTARS has been a local leader in advocacy. JeffSTARS participants go beyond Jefferson/Nemours and include senior medical students from Temple and Geisinger, pediatric residents from St. Christopher’s Hospital for Children and Crozer Chester, and medicine-pediatrics residents from ChristianaCare. The program director shares JeffSTARS challenges and successes at local community meetings and annual, national physician advocacy training meetings. Similarly, students have shared their work on toxic stress and other topics at local public health and national academic meetings. A Johns Hopkins pediatric resident, Laura Livaditis, wrote an award-winning essay on toxic stress (attached pdf) published in Pediatrics. After receiving the award, her first call (after her parents) was to the JeffSTARS director, attributing her success to the skills and inspiration that resulted from the month-long, experience she had as a JeffSTARS student with the Youth Sentencing and Re-Entry Project, where Laura focused on toxic stress, adolescent behavior and youth sentencing.

Sustainability

JeffSTARS, launched in 2009, has institutional support from Jefferson and Nemours, allowing the program director to dedicate one half-day/week. General Pediatrics funds the Educational Coordinator, who devotes five half-days per week to JeffSTARS, and provides office space, computers, conference rooms and phone lines. Embedded in pediatrics, JeffSTARS has faculty in family and community medicine, internal medicine and obstetrics and gynecology. Among the many long-standing community partners are the Pennsylvania Chapter of the American Academy of Pediatrics, the Maternity Care Coalition, and the Public Citizens for Children and Youth. Among our newest partners are the Timothy School for children with autism spectrum disorder, Attic Youth, and the Children Crisis Treatment Center. JeffSTARS has over 60 physicians, public health experts, and executive directors who speak at our training sessions. The program relies heavily on community agencies who expand the capacity of the program and help to drive the topics discussed.

Replicability

The JeffSTARS program can be adapted to other training programs and locales. A detailed description (attached pdf) and implementation toolkit of the month-long community experience is available on MedEd Portal, an online journal that allows for dissemination of information in the health professions. For each of the JeffSTARS components – Advocacy Journal Club, Advocacy Cafe, community site visits, and the month-long elective — we have transferable, written guidelines and assessment tools. Having guests from community organizations help to lead discussions has strengthened relationships and collaborations, and it has helped physicians gain familiarity with local programs and resources. Developing this type of network, large or small, is possible with ongoing commitment in any location where child health advocates are willing to work together.

Results/Outcomes

JeffSTARS has resulted in cultural change, where participating clinicians are careful to use an informed approach to patient care. Thanks to work with My Sister’s Place and Maternity Care Coalition, mothers in drug recovery are not “former addicts,” but rather women recovering from substance use disorder. Having spent the day at the Timothy School, young physicians now understand the importance of patience, familiarity, and repetition when helping children with autism spectrum disorder to learn. JeffSTARS has contributed to citywide efforts to help educators and judges understand the effects of toxic stress and trauma on children and youth. At state and federal levels, JeffSTARS has fought against conversion therapy, a emotionally detrimental practice permitted throughout most states that attempts to change an individual’s sexual orientation or gender identity. A major outcome of JeffSTARS is training future doctors to advocate for patients with and at risk for behavioral health problems.