Pediatric Environmental Health Toolkit

This is a Fall 2003 Newsletter Featured Article.

Other Featured Articles:

• Outreach on Toxic Threats in Massachusetts
• SMART Security: PSR's Plan for Preventing Preemptive War
• Environmental Pollutants and the Immune System
• Issues and Media Training at Harvard Medical School

GBPSR and sister chapter San Francisco Bay Area PSR are teaming up on an exciting new project that will bring practical tools on preventing exposures to toxic chemicals to pediatric and family care practices around the country. The Pediatric Environmental Health Toolkit includes laminated desk and pocket reference guides for providers and patient handouts including "Prescription for Prevention" sheets and refrigerator magnets.

We are pleased to have a distinguished group of pediatricians involved in the planning and development group. They include Guenter Hofstadler MD and Brian Linde MD who drafted the initial guidelines, and Mark Miller MD MPH, Lisa Asta MD, Siobhan McNally MD, and David Wallinga MD who are participating in revising and editing and will help oversee the pilot testing of the materials. SF Bay's Program Director Julie Silas JD is another key player, with Maria Valenti and Michelle Gottlieb MEM of GBPSR leading the East Coast team.

Parents, Providers Concerned About Kids Environmental Health

Pediatric Environmental Health is a relatively new field prompted by concerns about such things as pesticide residues on foods, mercury in fish, and arsenic in drinking water and on play structures. Yet, numerous providers have hardly heard of it.

Studies have shown few environmental histories are taken, and that less than one-in-five pediatricians reported having received training in environmental history-taking even though they strongly believe in the importance of environmental exposures in children's health. The issue is a high priority with parents. In a recent paper written by Dr. Sophie Balk, outgoing chair of the American Academy of Pediatrics environment committee and editor of the AAP "Green Book" for pediatricians, "…environmental exposures are among parents' top concerns for their children."

This interest in environment and health issues has also been demonstrated through GBPSR's In Harm's Way trainings for health professionals. Pediatricians have regularly comprised the largest fraction of physician attendees at conferences.

Using "Teachable Moments" During Well-Child Visits

Initial assessment of need for the Toolkit was conducted by surveying participants at In Harm's Way Trainings. Follow-up discussions with practicing pediatricians, and the organization of a pediatric planning group, led us to begin considering the optimum framework for the type of succinct, easily accessible reference materials the physicians told us they wanted. Noted pediatrician T. Berry Brazelton's Touchpoints concept was mentioned repeatedly as a model that could work for the materials, which we began to think of as a multi-part environmental health "toolkit" for both providers and patients.

The beauty of the Touchpoints program is that it makes it quite easy for the practitioner to impart environmental health information during "teachable moments" with patients.

Materials in Development, Soon to be Pilot Tested

The Toolkit materials are currently in development. Early feedback from providers has been extremely positive.

Included in the Toolkit are:

For Providers:

• A 2-sided, laminated provider desk reference card that includes:
  • Key concepts and principles in pediatric environmental health A summary of children's unique susceptibilities to toxic substances
  • Brief suggested Environmental History
  • Brief summaries of major toxicants and their potential health effects
• A 2-sided, laminated pocket reference card containing priority anticipatory guidance keyed to specific developmental stages to use during well-child visits.

For Patients:

• Educational handouts that include:
• • "Rx for Prevention" prescription slips keyed to developmental stages
  • Magnets with "Tips for Prevention"
    
  • "Out of Harm's Way" fact sheets

Conducting a Pilot Study

One of the primary goals of the project is to test the materials in real practice with pediatric and family practitioners. We are currently in the process of selecting pilot sites around the country that satisfy the strategic objectives needed for proper evaluation, including a good demographic mix to obtain feedback from an economic, cultural, and geographic cross-section of practices.

Many thanks to the Bauman Foundation, the Mitchell Kapor Foundation, and the Alida R. Messinger Charitable Lead Trust for funding the development of this project, and The John Merck Fund for a two-year grant to finalize materials and conduct pilot testing and evaluation.