Another Man’s Moccasins

Character Education Partnership sent out a few holiday mailings in end of Novembver-early December.  From the intellectual high-jumps of creating spreadsheets with different categories for different mailings and signatures, to the physical mud run of folding, sealing, and stamping envelopes, I’ve gained a deeper appreciation for teamwork and for physical donation requests.  Out of sympathy for the labour, it’d be nice to be able to donate substantially to every non-profit that’s hit me up for cash in the last month.  Though I’ve volunteered at non-profits in the past, working for one has viscerally made me appreciate how much donations count.

Holiday Hats

My job at NYCCD is not always particularly glamorous. I was reminded of this during the hours I spent on the stage of our special needs preschool wrapping toy after toy to be distributed to each of the 80 students (plus some of their siblings), snacking on chocolate covered pretzels and Pepperidge Farm cookies and jamming to the non-stop Christmas music on 106.7 lite FM. I was reminded of this yet again as I cheerfully donned a cheap Santa hat at the NewYork-Presbyterian pediatric clinic so that I could better fit in with the other festively-dressed registrants behind the front desk checking in the children for their doctors' appointments. I have learned again and again that meeting the needs of my organization often requires this foregoing of glamor. The school's holiday season needs, among other things, required a food preparer to heat up the dishes for the International Feast, and an amateur graphic designer to create the holiday party invitation: I wore both of these hats this year. Yet as I sit in the pediatric clinic waiting room and listen to a mother describe how her young daughter cries almost every night now that her father no longer lives with the family, or to a mother who is completely overwhelmed by her son's behavioral problems and believes that he may be bipolar, I realize that this principle applies just as much on an individual level as it does on an organizational level. The needs of others are oftentimes far from glamorous, and this fellowship has been a window into the lives of those who have experienced much more hardship than I have.  At times I am saddened by my own inability to help some of the children I encounter--what can I do when a mother of a three-year-old who is barely speaking refuses to bring her child to see the psychologist because she believes she is fine? However, sometimes meaningfully meeting the needs of others simply requires one willing ear in a room full of crying babies to listen to a mother's concerns and tell her that someone is here who can help her. It requires one person to set fears, preconceptions, and judgment aside; meet the family where they are at; and reassure them they are not alone. I am proud to say that I have worn this hat this year, and I look forward to continue wearing it in 2013.

The Breast Care Center

I've done a poor job posting about my Project 55 position at the UCSF Breast Care Center (BCC), but am trying to change that this weekend. I'll start with a general post about the internship program, and then follow it up with posts about my specific work and life in San Francisco.

I began work at the BCC at the beginning of July. The collaboration with Project 55 is just part of a broader BCC intern program. There is another fellow from Princeton, a few from Harvard (they have a similar partnership), and then a number from other schools. In total, there are 10 interns. One just took the MCAT, and will be applying to med school next year, but the other 9 are all applying now.

The program really is set up as a nice 1 or 2 year commitment for students who might be interested in medicine, and it's viewed more as an educational opportunity than a strict job. At the beginning of the year, we had talks with different doctors in the clinic on breast oncology, surgery, reconstruction, pathology, and more. We are encouraged to go to the weekly meetings such as Tumor Board and other lectures that take place at UCSF (there have been a few on health policy, for example).

The student interns are involved in a number of different trials that go on at the Breast Care Center. Some of them are breast cancer drug trials, such as I-SPY 2 (which is what I am working on). Another big project is the ATHENA Breast Health Network, a UC-wide collaboration that aims to follow women screened for breast cancer and generate a repository of risk and outcome data. There are also quality of life studies, including yoga classes to prevent lymphadema and scalp cooling caps to be worn during chemotherapy to reduce hair loss. Within each of these trials, interns also take on different roles. Some are clinical coordinators, and do a lot of the work to consent patients for the trials, schedule appointments, follow up with patients, and make sure that the trial generally runs smoothly. Other interns are involved in laboratory work, policy research, and health economics research. Since there are so many different positions, and so much to be done at the BCC, there is the opportunity to tailor projects to your own strengths and interests (computer science majors, for example who work on the IT side of trials). Most of these projects have websites and other information online, so I would encourage anyone applying to get a sense of which projects most interest them. Of course, the day-to-day work on any given project may not entirely recapitulate the overall aims of the research. These studies are often long-term, and clinical trials do involve a lot of data collection/entering, paperwork, and so on.

The one constant for everyone in the internship is Decision Services, which is a sort of patient advocacy program. A lot of patients coming into the BCC have treatment options, such as the choice between a mastectomy or a lumpectomy with radiation. Especially for women who have been recently diagnosed, these appointments come at an emotional, stressful time, and can include an overwhelming amount of information. We work with many of these patients, calling them before appointments to help them to generate a written list of questions for their doctor. We then accompany the patients to their appointment, taking notes for them and making an audio recording. Patients really appreciate the service, and the comfort of having someone navigate the process with them. It's also informative and powerful for us as interns, because we really get to know the patients and become intimately aware of their priorities, goals, and fears about treatment. Someone once said that it is more like shadowing the patient than shadowing the doctor, and I certainly agree with that assessment.

I'll follow this post up with more details about my specific work and experience in San Francisco. If you can't tell from this post, though, I'm having a great time at the BCC. It's certainly a good deal of work, but I've had a lot of new experiences and have learned a tremendous amount.

After Six Months

After six months at my placement at Greater Baden Medical Services, I have learned far more than I could have imagined.  I am becoming thoroughly educated on the challenges of delivering health care services to diverse populations and also on the excitement and uncertainty that the Affordable Care Act is bringing to health care at the local level.  Working in the administrative offices of a multi-site health center, I truly did not know what to expect in terms of my exposure to clinical situations, policy implications, outreach and groundwork or business related meetings.  It turns out that what I have experienced so far has been a blend of all of these areas, which has given me a perspective on health care that I did not have before. 

I have followed the developments of health care reform at the national level closely over the last several years but had thought more about what it would mean for patients than for those who provide health care services.  For Greater Baden, it could completely change our payor mix, the ratio between types of reimbursement that we receive (Medicare, Medicaid, private insurance, etc.).  It could also allow our patients more health care options, giving us more competition, or potentially turn many new patients in our direction.  Front line staff and case managers may be asked to play even more of a role in helping to ensure that patients are enrolled in the insurance options that is best for them.  Providers may have procedures or exams that they start to provide more or less frequently than they do now as insurance requirements and plans change.

After six months I am certainly far from being an expert on health care reform and after six more I’m sure that I still will not be, but the breadth of people I have been able to work with at Greater Baden has opened my eyes to some of the many challenges and opportunities that are coming along with this effort to improve health care for Americans. 

Reflection

I realized recently that I will be nearing the half-way point of my fellowship in a month. I'd settled into such a steady, predictable rhythm with my work at CEP that I'd almost forgotten to reflect and occasionally take stock of what I was learning and how I could use it in the future.

From my current vantage point, one thing I think I understand is that first, working in an office has been an incredibly valuable, educational experience and second, it's not something that I think I want to spend my career doing. CEP is a really great place for people who think they might be interested in education in any capacity, whether policy or teaching or administration because in addition to the office work, you are also constantly in contact with teachers, school social workers, administrators and counselors. During our recent conference, I was actually able to sit in on multiple enrichment and training sessions for teachers and meet a lot people on the front lines of character education and many different kinds of education reform.

Additionally, one of my current projects is proofreading our massive, 500-page sourcebook, which is filled with examples of really exciting things that teachers are doing around the country. This fellowship is a really amazing opportunity to get a sense of how exciting and creative teaching (or working in a school in a different capacity) can be from a macro level, to see teachers who are doing genuinely innovative, effective things. Learning more practical skills, like communicating with supervisors and working independently is also valuable but I only recently realized that there are so many other, much broader things I've gained from my experience.

Extreme Fellowship Makeover

It's pretty crazy how quickly a job can change in one week.

As of last Wednesday, NYCCD officially opened its Early Childhood Mental Health Consultation and Treatment program in the pediatric primary care clinic of NewYork-Presbyterian/Weill Cornell Medical Center. What this means is that one of three NYCCD psychologists and I (my title is the Primary Care Assistant) will be onsite in the clinic every afternoon administering a standard mental health screening to all children birth to five who are coming in for their well-baby visits. Let me break this down to give you a better idea of what my role looks like.

1. I arrive at the clinic after a morning of doing work at NYCCD's 62nd St. office at around 12:45 PM--enough time for me to check in and score a $5 meal voucher that NYP distributes to all of its volunteers (which technically I am because I am paid by my organization, not the hospital). I find this to be extremely exciting!

2. I head over to our clinic office in order to go over the schedule of children we are supposed to be screening that day, which I usually try to make the day before. I prepare all of the different screenings we will  be using according to the children's ages, and then I mentally prepare to enter the chaos that is a pediatric primary care waiting room--my workstation for the afternoon.

3. I distribute the schedule to each of the front-desk clerks (called registrants) who check in the families when they arrive for their appointments. They will help alert me to when one of our scheduled children arrives. Then, I get settled at a computer that I have been given permission to use behind the front desk, and I log into the hospital database. From there, I can track when the patients arrive and where they are during their appointment (getting their vitals, seeing the doctor, getting bloodwork, etc.)

4. I check the clinic schedule on the hospital database to see whether any of our scheduled children have already arrived. If one of them has, and their status in the database indicates that they may be in the waiting room, I call the child's name in order to find them in the waiting room.

5. I then head over to the parent, screening and clipboard in hand, and channel my best patient-friendly vibe (invoking all that is warm, approachable, and knowledgeable!) as I introduce myself and the purpose of the program. I assure the parent that we are asking all parents with children 5 and under to complete the questionnaire (some get a little defensive when I ask them to answer questions about their child's development and behavior). I then inform them that, should they have any questions or concerns regarding their child, we have a psychologist onsite who is available to talk to them at a time that is convenient for them. I ask them if they have any initial questions or concerns they would like to talk about, and then, after a few more instructions and a big "thank you" for participating, I leave the family to continue on with their appointment.

The rest of my afternoon escalates into a frenzied flurry of activity that defies linear numerical outline formatting. Between tracking down the families, explaining the screening, tracking them down again to get the screenings back from them, scoring the screenings, filling out the cover sheet for the NYCCD psychologists' review, tracking down yet again those families whose responses indicated that there may be some concern regarding the child's development, determining whether they would like to speak with the psychologist, and facilitating a warm hand-off or scheduling a later appointment with the psychologist onsite, I rarely have time to get a drink of water or use the restroom, let alone do the rest of work that goes along with the position--following up with the parents whose children are currently seeing our psychologists or who were referred for other services by our psychologists, writing my notes on each child who presented some sort of developmental or behavioral concern that day, and creating the schedule for next day! For now, as I am trying to adjust to the new routine, it is exhausting work. However, it is extremely rewarding to be interfacing directly with the parents, serving as the first person that parents can turn to if they have a concern about their child's development, and working with the NYCCD mental health team start up this exciting new program. I'm looking forward to seeing how it progresses in the coming months--and to helping make it happen.

as good a time as any

...to make my first blog post! With the PP55 application date approaching, I thought I would make a quick plug for the program and explain a little about what my experience has been like. The rest of the site explains the components of the PP55 program -- the monthly seminar series, the mentorship program, the social events, the meaningful job placements -- but I want to hereby testify that it really is everything they say it is. I've learned about green architecture while sipping wine on a Wednesday night, rubbed shoulders with successful and generous "old timers," one of whom mailed me tickets to a Picasso opening a few days after we first met, and learned so much about my own skills and interests through challenging tasks at work. I work at the Association to Benefit Children in the Programs and Contracts office -- so, along with my fellow fellows, I write grants, manage our contracts with the government, and balance the many other things we have to do in order to keep our programs running. It's a big mix of writing, researching, working with numbers, people-managing, organizing, event coordinating, and a little bit of reviving my 10th grade Spanish skills. I work on a different project every day. I don't feel overworked, but I am constantly busy and challenged. And learning. And I think a lot of the fellowships are like that. I feel really important, too -- if I didn't submit a big contract the other day, we wouldn't have received a $10,000 city council grant. Just because these are one-year stints doesn't mean we aren't crucial to our organizations! If you're thinking of applying to PP55, I really recommend getting in touch with a current fellow to learn more about the program and get a sense for the different fellowship placements. It's a really cool way to start your career and continue to take advantage of Princeton's incredible resources post-graduation. And giving back to the community is great karma!!