The Goshen non-profit organization was founded in 2010 by Israel’s leading pediatricians and Australia’s internationally renowned Professor Frank Oberklaid to answer the urgent need to advance children’s optimal health, development and wellbeing by transforming the way that services are delivered to children and families.
With ongoing support from US and Australian funders, Goshen works with the Ministry of Health, physicians, policy-makers and partners across the community ecosystem to significantly change the landscape of early childhood development in Israel. This is especially relevant in underserved communities and for marginalized populations.
“Goshen has introduced a new way of thinking,” says the organization’s chairman, Prof. Eitan Kerem, former head of Hadassah’s Division of Pediatrics. “It is integrating the work of the many childcare professionals – bringing pediatricians, family doctors and nurses together with psychologists, social workers, kindergarten and school teachers, welfare and community workers. In doing so, it’s ensuring that every child in Israel receives integrated care that focuses not only on health, but wellbeing – a priority nationwide, and especially urgent outside the country’s major cities.”
Filling a healthcare void
In Israel, if your child has a fever, you go to your local Health Fund pediatrician, who will likely resolve the problem quickly and professionally. But where do you find help for healthcare needs that are less obviously medical? What if you’re worried about what your child eats, about toilet training, behavior, sleep patterns or language development? What about learning difficulties and internet use, sibling jealousy and peer pressure? What is healthy sexuality in children and what is not? How do you manage the impact of chronic disease or fragile mental health in your child?
“Issues like these can fall through the healthcare cracks, and lead to long-term social, emotional or psychological fallout,” says Dr. Hava Gadassi, who did her specialization in community child healthcare in Australia. “Pediatrics training in Israel is high-level, but it’s hospital-based, and that leaves a void in Israel’s social and healthcare structure.”
Pediatricians who work in the community are not trained to deal with psychosocial aspects of care, such as neglect or economic distress, or behavioral, developmental or learning problems, she explains. “They are not fully equipped to evaluate the strength of the family and how it can help the child, or to connect with national children’s NGOs or the many fragmented local education and welfare systems.” Goshen works to change this.
“Community pediatricians have been very receptive”
Goshen’s beginnings date to mid-2009 when Hadassah’s Pediatrics head was approached by Australian community child health specialist Prof. Frank Oberklaid. Director of the Royal Children’s Hospital’s Center for Community Child Health in Melbourne and widely celebrated in his field, Prof. Oberklaid proposed bringing the Australian model to Israel. The following year, representatives of Israel’s child-health stakeholders – the Israel Pediatric Association, hospital pediatric departments, pediatric associations, the Health Funds and child healthcare organizations – met in Tel Aviv, and Goshen was born.
A first step was sending Hadassah pediatrician Dr. Gadassi on a two-and-a-half year Fellowship to study child community health under Prof. Oberklaid at his Center in Melbourne. She returned to Jerusalem in 2012 as the first specialized Goshen pediatrician.
“Because every child in Israel sees their local pediatrician, the community pediatricians were our entry-point,” she says. Aiming to give primary-care physicians tools and skills beyond diagnosing medical issues, Goshen designed a course on developmental, behavioral and psychosocial problems in infancy and early childhood – how to pick up on them, how to talk to the families about them, and how to help them access the right interventions. That first Goshen course was taught in 2013 and drew 30 pediatricians from all over Israel. Held annually ever since, it has reached physicians from every part of Israel’s social mosaic – Jewish, Christian and Muslim, secular and Orthodox, urban and rural.
Shorter seminars and workshops for community doctors, nurses, pediatric interns and community child caregivers have also been developed and run by the Goshen team, with close to 3,000 participants benefitting from Goshen’s content.
“Community pediatricians, in fact all healthcare workers, have been very receptive,” says Prof. Kerem. “They’re aware they should be involved in the health challenges of the whole community. They’re eager to know more so they can work more effectively – whether it’s childhood obesity, early detection of behavioral problems or responding to Covid-19.”
Extensive online presence
Goshen, with its high community profile and an active social media presence, was uniquely prepared to respond to the coronavirus emergency. “Although Covid-19 rarely infects children, it constitutes a crisis in child healthcare and community pediatricians are on the frontline,” says Dr. Gadassi. “We began by conducting webinars on its medical and social impact on child health, which attract 100 to 150 pediatricians from all over the country each time. We have now incorporated professional webinars into Goshen’s ongoing activities, and we have received incredible feedback from the field. The webinars deal with issues such as sleep challenges, breastfeeding, bedwetting, eating disorders and children with special needs.
“We’ve designed and uploaded videos and Information sheets in Hebrew, Arabic, Russian, English, French and Amharic for parents and grandparents about how to occupy children at home, juggle insufficient devices for distance learning, manage screen time, maintain child safety during the pandemic, eat healthily and handle financial and mental stress during lockdown.”
Addressing primarily young families (although there are sections for grandparents, too), Goshen makes intensive use of social media. Its website, How You’ve Grown! (www.gadalta.org), is a comprehensive online parenting resource for Hebrew- and Arabic-speaking parents that receives over 60,000 hits a month from all over Israel, and beyond.
“Our Arabic-language website gets around 20,000 hits a month, several thousand of them from Saudi Arabia, Egypt, Iraq and Lebanon,” says Noa Bronstein-Amon, Goshen’s Content Development Director. Goshen also has a lively Facebook page, a busy presence on Instagram and YouTube, and organic Google search engine optimization. It is now working with a number of philanthropic partners including Keren Beracha to adapt its information to the cultures it serves – Ultra-Orthodox, Arab, Ethiopian and more.
Transforming Israel’s well-baby healthcare
Although community pediatricians were Goshen’s first target, nurses come a close second. “Israel’s well-baby network, Tipat Halav, is the first healthcare station for pregnant women, infants, children under six and their parents,” says Prof. Kerem. “Over 100 years old, it works today with a very different population, parents who are engaged and informed as never before. So, we’re reframing how its nurses support and promote parenting practices that contribute to healthy development of children in the first years of life.”
The Tipat Halav initiative is a partnership between Goshen, Israel’s Ministry of Health, the Bernard van Leer and Yad Hanadiv Foundations, and Lotem Strategies. It is expected to transform Israel’s well-baby care. Thirty-four Tipat Halav clinic head nurses from all over the country completed a one-year leadership program in which they expanded their skills in working with parents, developed leadership and together with the project team developed a professional framework that they will implement over the next years throughout Tipat Halav.
And, at the request of the Jerusalem Municipality and Jerusalem Foundation, Goshen has worked with Arabic-speaking lecturers and overseen translation of its training videos, presentations, handouts and experiential learning tool kits into Arabic for a course taught to 30 Tipat Halav nurses from East Jerusalem.
Ten years in, despite all it has achieved, Goshen sees itself as scarcely having left the starting post. Among the key ‘deliverables’ it has set itself are redefining pediatric care to focus on the total health and wellbeing of the child; introducing community pediatrics into pediatric residency training programs; and establishing centers of excellence for community pediatric care in Israel’s periphery.
“Children are 30 percent of our population, but they’re 100 percent of our future,” says Prof. Kerem. “That makes them our very best investment.”