Western Partners Trainee Spotlight: Georgia Brown & Nicole Thelan

This blog post highlights the work and experiences of two funded MCH trainees from Oregon Health and Sciences University (OHSU), Georgia Brown (left) and Nicole Thelan (right).

Georgia is a 1st year trainee at OHSU in Portland, Oregon. She is currently completing her Masters of Science degree in Human Nutrition in combination with her dietetic internship at OHSU School of Medicine, with a thesis focus in fatty acid oxidation disorders. She received her Bachelor of Science in Nutrition at Arizona State University in 2016. Georgia has a variety of interests including inborn errors of metabolism, disorder eating in adolescents and adult women, behavioral health and food insecurity.

From Georgia: “During the Winter 2019 term at OHSU I took a Maternal Infant Child nutrition course, which emphasizes the growth and development of a fetus during pregnancy up until young adulthood. In this time, I completed two presentations which included a focus on adolescent girls and body image with the use of social media, and another on pregnancy in bariatric surgery patients. Both presentations provided unique opportunities for learning about two distinct populations, all while still learning about maternal and child health. I felt these in-depth presentations afforded me the opportunity to continue building off my MCH competencies while exploring topics of interest to me, including disordered eating behaviors and pregnancy.”

Nicole is a 1st year trainee at OHSU and is finishing up her second year of her Master of Science in Human Nutrition. Nicole obtained her Bachelor of Science in Nutrition at Seattle Pacific University where she participated in the Community Kitchen program. This program aims to provide affordable meals to community members while teaching meal planning and cooking skills. As part of her graduate experience, Nicole spent 4 weeks interning at the Multnomah County WIC department and 2 weeks rotating in the Pediatric Metabolic Clinic at OHSU. Nicole’s nutrition related interests include gastrointestinal disorders, community nutrition, public policy and food insecurity.

Highlights of MCH Nutrition Traineeship

As MCH trainees, we have had the pleasure of immersing ourselves in a variety of maternal and child nutrition related opportunities, including attending weekly Leadership Education in Neurodevelopmental and Related Disabilities (LEND) seminars which is a traineeship that provides graduate level interdisciplinary training and education. This traineeship focuses heavily on interdisciplinary work among a multitude of disciplines including Registered Dietitians, Speech Language Pathologists, Audiologists, Psychologists etc. with the goal of improving health outcomes in infants, children, and adolescents with disabilities. As attendees we were able to observe seminars with guest lecturers from both providers and patients/families, along with participating in a healthy discussion on how we can improve the health care experience for families. This opportunity has provided the unique experience of working specifically with families and children with disabilities, providing exposure and training on how to work with this commonly underserved population.

We also had the opportunity to attend the Western MCH Nutrition Leadership Network conference in February. The conference afforded us the chance to listen to the activities and accomplishments of the other trainees in our network and enhance our understanding of policy, system and environment concepts. We both walked away with a significantly deeper grasp of how to incorporate these ideas into our future practice as dietitians. Furthermore, the conference included a full day of education on building and further cultivating our leadership and communication skills — both of which will be key as they will allow us to go forward and make a meaningful difference in the lives of women and children, and really all people we work with.

We are currently working with the Multnomah County WIC office to develop a continuing education presentation for their providers. After hearing from the providers regarding a list of topics they would be interested in, we chose to focus on fad dieting for mothers and children. We plan to present on a range of diets including the ketogenic diet, veganism/vegetarianism, and the gluten free diet. Our goal is provide education the providers may apply in their practice and to help them answer questions they may receive from families about the practicality of these various diets for young children and pregnant or lactating mothers. Finally, we will be providing some online educational materials for the OHSU Hemophilia clinic and will specifically be focusing on topics families may find useful or interesting.

Child Obesity:  Reflecting on strengths-based approaches to clinical care and looking forward to positive deviance approaches to research

Hooper_PhotoLaura is a 1st year trainee at the University of Minnesota – Twin Cities. She is pursuing a PhD in Nutrition and a doctoral minor in Epidemiology at UMN. Her research is focused on the intersection of obesity and disordered eating in children and adolescents. She is interested in understanding how external factors such as weight stigma and food insecurity impact health outcomes in these populations.

I was thrilled to learn that I would have the opportunity to work as a research assistant on the Positive Deviance Child Obesity Supplement for the MCH Nutrition Training Program here at UMN. What is Positive Deviance you ask? Positive Deviance is an innovative approach to public health research. Traditional research approaches investigate the sick, focusing on a particular disease. They focus on identifying risk factors associated with a particular disease, reducing modifiable risk factors, with the goal to mitigate the population’s risk for developing that disease. Positive Deviance uses a different approach. In Positive Deviance, instead of studying the “sick,” researchers study the “well.” Within an at-risk population, they ask who does not develop the disease? They aim to identify protective factors or protective behaviors within the “well” population. Finally, they aim to promote those protective behaviors within the at-risk population.

For the Positive Deviance Child Obesity Supplement, the condition we are studying is child obesity. We will be looking at 2- to 5-year-old children who are at risk for developing obesity. Our goal is to identify the characteristics that are associated with (and possibly responsible for) not developing obesity. For example, which children do not have accelerated weight gain and what characteristics do they share?

Why am I so excited about this approach, you ask? Well, before I returned to graduate school to purse a PhD, I worked as a MS, RDN for 10 years in child and adolescent obesity clinical programs at Seattle Children’s Hospital. We used a strengths-based approach to clinical care. We partnered with children, adolescents, and their families to help them to see what they were already doing well, then we built upon those strengths as we set SMART goals (Specific, Measurable, Agreed-Upon, Realistic, and Time-Oriented). I saw firsthand how helpful it was to patients and families when our clinical team was able to empower them to feel good about what they were already doing and then make changes based on those strengths. When I was first being trained in this approach to clinical care, one of my mentors used this analogy: “You don’t teach a child to read by listing off all the things they are doing wrong. You start with what they are doing well and then build from there.”

Even though the strengths-based approach to clinical care is not the same thing as Positive Deviance research, they both focus on investigating what is going well rather than investigating what is going wrong. Child obesity is such a complex, multifaceted, layered problem, and previous research approaches have not been able to adequately prevent the condition from developing. It is a puzzle that has yet to be solved. Our research team is currently recruiting participants, and we will be collecting qualitative data this summer. I am very excited for the opportunity to participate in this innovative approach to research and eager to see what we discover!

Reference:

Alex Foster, MD, MPH https://www.youtube.com/watch?v=EOGHqDaiJL0&t=216s