A confused 2-year-old sat on the carpeted floor, surrounded by three enthusiastic women with a bounty of toys. His mother was anxiously awaiting our assessment a few feet away at a child-size table. This is not how I envisioned my pediatric training to be, but this day was an unexpected gift.
On that sunny Portland afternoon, I was at Early Intervention, a school-based statewide organization that provides free services to children ages birth to 3 with delays in their development. I was a part of a team that observed and interacted with the child for intake assessment.
This boy’s pediatrician was concerned about speech delay, and referred him to his county’s Early Intervention program for an assessment. An audiologist and an occupational therapist, both of whom had enough energy to fuel a bus full of kindergarteners, performed the assessment. One worked to engage him with games involving mimicking, parallel play and sharing, while the other recorded his response in an intricate booklet. After two hours of pulling countless toys from the shelves, the little guy was ready for a snack, and the assessment team was ready to discuss their evaluation and make recommendations to the boy’s family.
The time spent at Early Intervention was rich in learning and all part of a unique rotation known as CACH, or Child Advocacy & Community Health. As part of the OHSU Doernbecher Pediatric Residency Training Program, each first-year resident spends a month on the CACH rotation. The majority of CACH time is spent visiting the various community resources to which we refer many of our patients. Residents spend half or full days at Early Intervention, WIC (Washington County Women, Infant, & Children Program), Oregon Poison Center, the Oregon Food Bank, Outside In, Children’s Community Clinic, and many more. We learn exactly what happens at each of these fantastic sites in our community. We also spend time acquiring skills that will aid us in being effective child health advocates
CACH helped me gain awareness in areas I had not been exposed to in medical school or in the hospital. I learned the difference between assessing for speech delay and autism, how easy it is to get to WIC with public transportation and, conversely, how difficult it is to get to Early Intervention.
I now appreciate exactly what happens on an Oregon Poison Center call (those intake phone calls are the picture of efficiency), as well as what classes a family can take at the Oregon Food Bank (“Healthy Cooking,” “Gardening,” and on the horizon: “How to Raise a Chicken”!). These lessons were invaluable and will forever change the competence with which I refer patients to these resources.
On this journey to becoming a pediatrician, I commonly reflect with gratitude on the many teachers that have trained me thus far. Some have been expected: my peers, attending physicians, the nursing staff, and the parents of children with complex, rare medical issues. But just as precious have been the unexpected: the Early Intervention employees, lactation consultants, WIC nutrition specialists, social workers, the physical therapists at OHSU Doernbecher Healthy Lifestyles Clinic and employees at OHSU Doernbecher Children’s Safety Center employees, Oregon Poison Center RNs, and many more.
I am so grateful for all of the lessons that find me, whether surrounded by IV pumps at the bedside of an ill patient, or encircled by toys in an Early Intervention classroom. It’s all part of finding out how to best care for my future patients, and to do so it takes a comprehensive community.
Brenna Lewis, M.D.
First-Year Pediatric Resident
OHSU Doernbecher Pediatric Residency Program