2019 Parents Fund Internship Grant Reflections: Sarah Shepherd

Sarah Shepherd

Internship Location: Carilion's Child Development Clinic

Journal Entry #1:

Hi! My name is Sarah Shepherd, and I am a third year majoring in Youth and Social Innovation in the Curry School of Education. I recently finished my first week interning with Carilion’s Child Development Clinic in Roanoke, Virginia. Virginia’s general lack of mental health and child development services means that patients travel to this clinic from as far as Lee County which is over 3 ½ hours away. The clinic offers expert diagnosis and treatment for children with developmental disabilities and learning disorders such as Autism Spectrum Disorder, ADHD, anxiety, developmental or learning disabilities, as well as speech or language delays.

As an intern, I have shadowed many patient visits and have been able to help create new resources for families to provide direction after a diagnosis. By collecting information from people around the clinic, I have been able to create information sheets to give parents about proper social emotional development for their child based on their age range. Additionally, I have worked to update a list of outpatient therapies for regions all over southwest Virginia. In doing this, the lack of services in some of the more rural regions of Virginia struck me. While on the phone with a health care provider in Lee County, I discovered that 3 out of the 5 therapy centers that I was inquiring about had recently closed, meaning that many patients now have to travel to Tennessee for therapy or other outpatient treatments.

This week I also had the opportunity to meet with a therapist at Family Services of the Roanoke Valley to report back to the Child Development Clinic at a staff meeting about the services they offer to which we would be able to refer our patients. Family Services offers a wide variety of interventions for children and their families including play therapy, trauma focused cognitive behavioral therapy, parent training, and counseling. This meeting was a great opportunity both for me personally to learn about what services are being offered by different organizations and also to be able to relay that information back to the clinic so that they can utilize the resources in the area well and make appropriate referrals.

Overall, I feel like I have already gained a new and widened perspective on the field of child development as well as some of the challenges to providing interventions for children. Being in this environment has allowed me to experience first hand things that I have been learning about for the last 2 years. I am now understanding that all ideas will not translate well from the classroom into practice because of logistical challenges for families or healthcare providers. I am very grateful for this opportunity and excited to continue my learning experience throughout the rest of the summer!

Journal Entry #2:

In the past weeks, I have been working on a range of new projects at the Child Development Clinic. After several iterations, I completed the project of creating social emotional development guides for 8 different age brackets for children between the ages of 3 months and 60 months, that I was working on during my last blog post. I expanded these informational guides for parents to include: information on the importance of play as communication for a child, typical social emotional development in that age range, and activities to foster growth in social emotional development. We will soon start distributing these guides!

Another neat project that I recently worked on is a social story for our office. A social story is essentially a step by step explanation often with photos that explains what will happen and in what order things will happen during a certain occasion. Social stories were created with children with Autism Spectrum Disorder (ASD) in mind but this tool can find use far beyond serving children with ASD. Patients who have anxiety about doctor’s visits find social stories helpful because they can mentally prepare for the things that will happen. The social story for the Child Development Clinic is particularly reassuring because it shows kids that there are no shots or medical procedures; often, our physicians’ primary method of  diagnosis is through playing with the child. I even included pictures of all our care providers to help children who have been here before remember their previous visits. Working on this project was not only fun because it allowed me to be creative, but it was exciting to create something that would be of great use to children and their parents.  

The bulk of my work recently has been collecting and managing data for Carilion Pediatric’s research grant from the National Institute of Children’s Health Quality’s Pediatrics Supporting Parents project. This project aims to provide social emotional development screening for children to determine which children may benefit from intervention. My role in this research has been to score and record the results of the social emotional screener that we give to patients, report back to NICHQ on changes we are implementing through Plan-Do-Study-Act (PDSA) reports, and compile our final data measures. 

Working on this project has been challenging, but it has allowed me to use and expand upon skills that I am learning in my major, Youth and Social Innovation. The theory of change model that we utilize often in the YSI curriculum greatly resembles the PDSA reports I have worked on, which has given me a great sense of confidence in doing this task. I also greatly appreciate the different measures that we have had to collect in our research, because it reminds me of procedures I learned in my Evaluating the Effectiveness of Social Innovation class my first year. 

Overall, it has been exciting to continue to grow my knowledge and skills through these projects, and also to put into use skills that I have been learning over the past years.

Journal Entry #3: 

My experience at the Carilion Children’s Child Development Center was an invaluable one. I feel that I was able to be directly exposed to things that I am learning in my education at UVA, and gained a deeper perspective for what things look like in practice. Though the professors at Curry emphasize practicality, this experience made me realize the ways that ideas we have in the classroom and for assignments will not always be executed according to plan in the real world. Two examples come to mind for this. First, was that even within the clinic, some practitioners would prescribe multiple therapies to children which would require 2 or 3 appointments a week. My boss saw the ways that this was not practical for families who are single parent or low income, as many of the patient’s families were, so she sought to establish practical plans of action that would be feasible for the family to carry out and tailored to their needs.

Secondly, the research project that we were conducting through the National Institute of Children’s Health Quality’s Pediatrics Supporting Parents project required data that was indescribably time consuming to collect. Truly, if I was not managing the project, there is no way that others at the clinic would have been able to devote that much time to data collection. I spent many hours issuing surveys to patients, scoring this information, and coding the results into a database. Another key issue with these surveys was that they were written on an 8th grade reading level, which was inaccessible to many of the parents of patients. For reference, all of the other literature in the clinic is presented at a maximum of a 3rd grade reading level to maintain accessibility for patient’s families. Gaining this insight was invaluable for me, especially as someone who is currently conducting research at UVA. Being on the opposite end as the organization enacting the research allowed me a better understanding for what is feasible in terms of data collection, especially for organizations that are already overburdened.

Another valuable thing that I gained was learning by just observing. I sat in on appointments and occasionally scribed during them throughout the summer for a variety of children with a wide array of developmental delays. As time went on, I began to be able to anticipate what my supervisor would ask or diagnose as I started to notice these minute behaviors of children that are telling of different delays. These little tells are so hard to teach or describe in a classroom environment, but after seeing it directly in children, I under the value of practical experience with children and close observation of ways they interact with their families and peers.

This experience was one of great growth for me and exposed me to both a professional working environment as well as face to face interactions with populations I have a desire to serve. A lot of my work was self-initiated as I saw needs that I could meet in different areas that aligned with my skillset. From that I think the most important skill that I acquired was not only taking initiative to meet needs, but also aligning these tasks with my talents and skillset to be as helpful and efficient as possible.