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Outer Cape Community Resource Navigator Program: Rural Community Engagement-Driven Service Delivery

Fri, 03/03/2017 - 3:00pm

Moderator: Andy Lowe, Director of Program Management Resources, Outer Cape Health Services


Marta “Dikke” Hansen, MSW, Director of Behavioral Health

Andrew Jorgensen, MD, Associate Medical Director

Session Description

The Outer Cape Cod, Massachusetts region is famed for its beauty as a summer vacation destination. For many residents and migrant workers serving the tourism industry; however, the intersection of isolation, little affordable housing, and limited transportation options can exacerbate problems due to mental health, substance abuse, and co-occurring conditions. Police, emergency responders, and EDs encounter this at-risk population disproportionately. Outer Cape Health Services, the local FQHC, proposed a novel solution: a Community Resource Navigator (CRN) program. The CRN Navigator works with community partners to identify at-risk individuals, engage them right in the community, and guide them to appropriate services/treatment. A modified Self-Sufficiency Matrix based on evidence from other Navigator programs is used as a tool to prioritize needs. The Navigator then helps clients attach themselves to options that make sense. The CRN program is a departure from classical case management approaches that features a light touch, with contact in the community rather than requiring clients to “come in” to the health center. A unique approach is that the Navigator uses a community-donated bicycle to pedal her way around the narrow Provincetown streets which can become virtually impassable during the busy summer tourism season. In addition, the Navigator sees clients in safe, accessible public spaces such as the public library. A critical success factor is community engagement that builds effective relationships with community partners such as police, EMTs, councils on aging, community mental health providers, etc. Since beginning the CRN program, data has been collected that provides some unexpected insights into how the Community Navigator approach can be both an outcome- and cost-effective alternative to traditional case management or social worker-oriented interventions. In addition, the CRN program is proposed as the basis for a research initiative under the auspices of the University of Massachusetts Medical School Center for Clinical and Translational Science.

Removing Barriers to Provider Communication with Multicultural Patients

Fri, 03/03/2017 - 1:30pm

Video includes Symposium welcome and introductions. Navigate to 12:20 in the video for beginning of keynote presentation.

Dr. Margarita Alegria has been instrumental in conducting research to eliminate disparities in mental health care. During this presentation, she will discuss major challenges of working across ethnic boundaries and propose alternative approaches to overcome them.

The therapeutic relationship has long been recognized as an essential factor in facilitating client engagement and retention in care. We know the challenges of establishing a relationship are amplified when cultural differences exist between client and provider, as an unfamiliarity and/or discomfort with a client’s beliefs, practices, understanding of etiology, acceptable approaches of treatment, and communication style create additional complexity. Recent studies have highlighted the unfortunate manifestations of such cultural disconnects, including: the presence of diagnostic bias with clients of color; and, structural and interpersonal barriers that get in the way of establishing rapport.

This presentation is designed to help improve shared decision making in the clinical encounter. Dr. Alegria will cover a variety of topics, including perspective taking; frequent attributional errors that providers make; and increasing receptivity to client participation and collaboration in decision making. Ways to improve the ability to listen, empathize and ask questions effectively will be discussed as will increased awareness of provider perceptions and misperceptions. These skills are not only important for patients and providers, but for everyone, particularly when interacting with those who are different in culture, background, and life circumstances.

Health Characteristics of Employees Entering a Statewide Public Health Program to Improve Worksite Wellness

Fri, 03/03/2017 - 12:00pm

Introduction: The Massachusetts 'Working on Wellness' (WoW) program provides training and seed funding to employer organizations to initiate policies and programs that promote a healthy workplace and encourage a healthy lifestyle. We assess employee participants' health risks and their interests in wellness activities for targeting program efforts and for evaluating the program.

Methods: Between November 2015 and December 2016, 4 cohorts of employee participants completed a needs and interests survey at the initiation of the program. The survey collected self-reported information concerning health, risk factors, workplace environment and benefits, and worksite policies and programs of interest to participants.

Results: Among the 17,219 respondents, 62% were overweight or obese. Only 13% ate the recommended 5 servings of fruits and vegetables daily, and 26% did not exercise for at least 30 minutes at least 1 day per week. In addition, 32% did not get at least 6 hours of sleep each night, and 21% reported unhealthy level of stress. Interest in wellness policies that promote exercise, healthy eating, and stress reduction were endorsed by 68%, 57%, and 59% of respondents, respectively, with 63%, 44% and 56% indicating they would likely participate in such programs.

Discussion and Conclusions: These data demonstrate the need for wellness programs that promote healthy eating, exercise, and stress reduction, as well as employees' strong interest in workplace policies and programs that encourage these behaviors. A follow-up survey one year after program initiation is being administered to determine the short-term impact of WoW program.

Program Evaluation Approaches, Successes, and Lessons Learned from the Massachusetts Working on Wellness (WoW) Program

Fri, 03/03/2017 - 12:00pm

Introduction: The WoW program is a two-year training program to expand employer-based health promotion and prevention. This methodology poster describes the mixed-method program evaluation design and analysis.

Methods: Data collection instruments were designed to measure key program outputs and outcomes and pre/post-intervention comparisons. Enrollment surveys, satisfaction surveys, and wellness planning and evaluation tools and surveys were designed to capture organizational characteristics, training program quality, employer wellness program and policies, and employee health status and program interests at program initiation and 12-month follow-up for four cohorts of participating organizations. The All Payer Claims Database will be used to examine changes in healthcare utilization and expenditures. Mid-course focus groups with the program team assessed opportunities to improve training efficiency and quality. Follow-up interviews with wellness champions assessed satisfaction, sustainability and future program needs. These qualitative data are examined by main themes to describe contextual factors related to program delivery.

Results: The multi-layered evaluation approach was effective for evaluating this employer training program. The instruments gathered valuable data on employer and workforce characteristics and employee health concerns and program needs. Evaluation activities provided quality monitoring that contributed to satisfaction and effectiveness. Evaluating health impacts proved difficult due to insufficient follow up period. Evaluators had partial success with estimating possible health impacts using existing intervention research literature.

Conclusion: Using a multi-layered, mixed-method evaluation approach has many advantages for process and outcome evaluation. At least two years post-program implementation data is needed to measure health and cost outcomes for worksite wellness initiatives.

A Preliminary Method for Estimating Program-related Reduction in Employee Health Care Expenditures for the Massachusetts Working on Wellness (WoW) Program

Fri, 03/03/2017 - 12:00pm

Introduction: The WoW program is designed to improve employee health outcomes through workplace support of healthy behaviors. We illustrate a preliminary model to estimate the program effect on employee health care expenditures.

Methods: Program-related reductions in employee health care expenditures were estimated based on likely improvements in healthy eating, leisure-time exercise and stress reduction. The models considered the number of employers targeting these specific areas, the number of employees in each organization, prevalence of the specific risk factors, ranges of success rate in risk mitigation and program-associated decrease in health care expenditures from similar worksite studies in literature.

Results: Assuming success rates of 5% and 30% respectively for each of the top three targeted areas, the estimated total reduction ranges from $0.76 million to $4.07 million. For every $1 invested, the program could result in $0.38 to $2.04 reduction in healthcare expenditures by assuming an initial investment of $2 million in the intervention program.

Discussion and Conclusions: This preliminary analysis shows the likely ranges of return on investment (ROI) from the WoW program in relation to employee health care cost. The models should be further developed to provide more accurate estimates by including potential cost reductions due to other target areas, synergistic effects of successes in multiple areas, increased productivity and reduced absenteeism. Simulation models should be created to provide estimates along with precision based on employee-level data. However, methodological limitations remain to be addressed for use of intervention effects from randomized trials in ROI estimation in non-randomized practical settings.

Overcoming challenging barriers to community engagement associated with severe and persistent mental illness using evidence-based treatment interventions

Fri, 03/03/2017 - 12:00pm

Historically individuals who experience severe and persistent mental health symptoms are identified as experiencing chronic symptoms requiring long-term treatment. Treatment of these symptoms typically produces modest results and the focus shifts from achievement of meaningful and desired goals to maintenance of the individual's 'baseline' level of functioning. This leads to a cycle of long-term placement in residential or inpatient settings with relapses resulting in higher levels of care. Individuals trapped in this cycle tend to be insulated within a system of care and with little connection to the supports and resources in the community at large and few opportunities to engage in meaningful work. Our aim has been to systematically target those symptoms which create the greatest barriers for individuals working to return to living productive and enjoyable lives after the onset of mental health symptoms. To this end, we have worked to implement time-limited, targeted, and evidence-based treatment interventions. We have implemented Dialectical Behavior Therapy, Illness Management and Recovery, Supported Education and Employment, Cognitive Restructuring for Post-Traumatic Stress Disorder, Cognitive Behavior Therapy (CBT) for Psychosis and Recovery-Oriented Cognitive therapy to help individuals decrease self-injury and suicidal ideation, manage symptoms of severe and persistent mental illness, increase access to meaningful and valued work opportunities, and address complex trauma. Utilizing CBT-based interventions for these symptoms, that are historically challenging to treat, is the best way help individuals integrate into their communities and become less reliant the mental health system.

Working on Wellness: Building Capacity through Community Partnerships

Fri, 03/03/2017 - 12:00pm

Establishing a wellness initiative in the workplace is a popular way for employers to attract and retain top talent, reduce health costs, and increase productivity. However, building a comprehensive wellness initiative can put a strain on an organization's time and resources. Working on Wellness (WoW) is an innovative 'capacity building' program designed to help employers across Massachusetts implement evidence-based worksite initiatives and policies that foster a healthier work environment. To broaden the understanding among employers about what influences health, WoW's Community Partnerships component introduces organizations to the notion that businesses can play a key role in building healthy communities. The curriculum describes how employers can join efforts to improve the places where they live, work and play. Businesses are encouraged to incorporate interventions into their worksite wellness programs and policies that show mutually beneficial outcomes between employers and community partners. This poster will introduce tools and resources created through WoW including our approach to introduce community partnerships through our online training modules and our Community Scan assessment tool, which provides a roadmap to consider traditional and nontraditional partners for organization's wellness interventions. The poster will feature case studies highlighting how participants used the Community Scan to find and establish strong partnerships to reach their goals of increasing fruit and vegetable consumption, reducing stress, and increasing physical activity among employees and community residents. This poster is one of a series of posters on this project presented by the project team: UMass Medical, UMass Lowell, Health Resources in Action and AdvancingWellness.

Working on Wellness: A Capacity Building Program for Massachusetts Employers

Fri, 03/03/2017 - 12:00pm

In recent years, more worksites have shown an interest in offering wellness programs to their employees. However, uptake of worksite wellness programs remains low among certain employer groups, such as small businesses and employers in low wage industries. This poster will highlight the Working on Wellness (WoW) program; an innovative 'capacity building' program designed to help employers across the state implement evidence-based worksite initiatives and policies that foster a healthier work environment.

Through a collaborative partnership with the MA Department of Public Health, a public health institute, a cadre of worksite wellness experts, and university researchers, over 150 businesses were recruited to participate in WoW this past year. This poster will describe WoW's innovative framework, the tools and resources available to businesses (e.g., seed funding, community connections and collaboration, access to a comprehensive online curriculum, and technical assistance), and examine program strengths and weaknesses.

The methods used in this model to teach the concepts and skills of building a worksite wellness program will be examined. The evaluation aspects of the program, undertaken by UMass Medical and UMass Lowell will be identified.

Lastly, the poster will feature case studies of participating organizations, highlighting the interventions implemented in their worksites to impact employee health.

This poster is one of a series of posters on this project presented by the project team: UMass Medical, UMass Lowell, Health Resources in Action and AdvancingWellness.

Evaluating the Massachusetts Working on Wellness (WoW) Program Implementation: Successes, Challenges, and Recommendations for Improvement

Fri, 03/03/2017 - 12:00pm

Introduction: The Massachusetts 'Working on Wellness' (WoW) program provides training and seed funding to employer organizations to initiate policies and programs that promote a healthy workplace and encourage a healthy lifestyle. WoW is a partnership between the Massachusetts Department of Public Health (MDPH), Health Resources in Action (HRiA) and AdvancingWellness (AW). We evaluate the WoW program implementation to assess the program delivery and to make recommendations for program improvement.

Methods: Over the course of nine months, three group interviews were conducted with HRiA and AW staff during the program delivery period. Qualitative data collected focused on successes, challenges, and recommendations related to planning; recruitment; survey instrument development and administration; data collection; report development, generation and delivery; project management; communication and collaboration. These data have been examined, organized, and reported by main themes, in order to assess contextual factors related to program delivery.

Results: Successes, challenges and recommendations were documented. Examples of successes include clearly defined tasks and goals, dedicated team members, positive communication and collaboration, and evidence based evaluation methodology. Challenges include data suppression guidelines, time and customization of employer reports. Recommendations include better guidance for organizations, improving timing of evaluation report delivery, expanding networks, and implementing a solid recruitment plan, customizing outreach.

Discussion and Conclusions: Interview data suggested midcourse adjustments that were made to increase efficiency, uptake, and effectiveness for the subsequent cohorts. In addition, documenting successes, challenges, and recommendations, led to several adjustments, particularly in the areas of recruitment, survey design, report generation and delivery and program delivery.

Participating Organizations in Massachusetts Working on Wellness (WoW): Who Are They? What Wellness Programs Have They Put in Place?

Fri, 03/03/2017 - 12:00pm

Introduction: Most worksite wellness programs are offered by larger employers and accessed by healthier, more educated workers. Massachusetts WoW program is specifically designed to provide guidance in developing wellness programs, with a focus on smaller employers. We examined characteristics of participating organizations and their wellness policies/activity to evaluate the program outreach and delivery.

Methods: Organizational and workforce characteristics were collected through an enrollment application. An 'environmental scan' characterized baseline health-related policies and programs. Wellness intervention activities planned by employers were also collected.

Results: The 205 participating organizations are predominantly non-profit (61%) and highly represented by the healthcare and social assistance sector (33%). As a priority of WoW, about one-half of participating organizations have 200 or fewer employees and two-thirds have low-wage workers. At baseline, about half of participating organizations offered no formal wellness program and few policy/environmental supports to encourage wellness activities. The pooled workforce is 63% women, 61% non-Hispanic Whites, and 60% hourly wage workers. About one-quarter have only a high school education/ GED or less, and 17% work evening, night or rotating shifts. WoW has assisted employers to establish program goals, which were predominantly to improve nutrition, increase leisure-time physical activity, and reduce stress.

Discussion and Conclusions: The WoW program has successfully reached and delivered services to organizations that previously had no formal wellness program and few wellness policies or supportive environments. In particular, this program has reached a large number of small and moderate-size employer organizations, and a substantial number of low-wage, non-college-educated, and racial/ethnic minority workers.

Facilitating Access to Health Coverage and Care by Advancing Health Insurance Literacy

Fri, 03/03/2017 - 12:00pm

Although Massachusetts currently has the highest rate of health insurance coverage in the nation, reports suggest health care consumers do not fully understand how their insurance works. Thus, the insured and uninsured populations alike need ongoing support in order to develop health insurance literacy, defined as the degree to which individuals obtain, process, and understand information about health insurance in order to make informed decisions about choosing and using their coverage, which in turn can lead to positive health outcomes. Educating consumers and giving them tools and resources are strategies that advance health insurance literacy. Since 2001, the Blue Cross Blue Shield of Massachusetts Foundation (the Foundation) has awarded over $5 million to community health centers and community-based organizations throughout Massachusetts, through its Connecting Consumers with Care (CCC) grant program, to conduct outreach, provide education and help consumers enroll in health insurance and access primary care. In 2015, the Foundation focused its CCC grant activities to improve health insurance literacy and engage consumers to utilize the health care system more effectively. Grantees have collected data on common measures, using adaptable data collection tools (e.g., brief client surveys), to assess changes in clients' knowledge, confidence, and/or preparedness to better navigate complex systems of coverage and care. The poster presentation will discuss: - the importance of health insurance literacy and its relevance to improving population and community health - strategies currently used to increase health insurance literacy among diverse populations, including successes and challenges - how the impact of these strategies was measured - how assessments were designed to reflect consumers' voices.

Assessment of Diet in Patients with Inflammatory Bowel Disease: A Collaboration of Behavioral and Basic Scientists

Fri, 03/03/2017 - 12:00pm

Introduction: Clinical research to develop treatment for inflammatory bowel disease (IBD) is focusing on a nutritional regimen restricting certain carbohydrates while incorporating the use of an optimal diet that includes pre- and probiotic foods. Current assessments are not able to measure elements of this nutritional regimen, thus we developed a food frequency questionnaire (FFQ). This FFQ will be utilized in a prospective study of IBD patients following an anti-inflammatory diet (IBD-AID) developed by us and used clinically at UMASS. We will track the bacterial communities inhabiting the microbiome of patients to determine diet-dependent changes, and their relation with patient wellbeing.

Objectives: 1) Develop an FFQ capable of identifying dietary components important to IBD: prebiotics, probiotics, beneficial nutrient intake, and avoidance of certain foods. 2) Determine diet-dependent changes of the gut microbiome.

Hypothesis: This study will show the microbiome of patients adopting the IBD-AID converge to one or more healthy 'enterotype' signatures, as compared to a non-IBD-AID control group.

Experimental design: Patients record daily FFQ. Foods and food groups (270) are categorized and grouped according to criteria of interest. Each food has a referent by which the patient can compare their own consumption. A scoring system satisfying dietary guidelines and components of the IBD-AID will be utilized. Twice per week patients collect stool samples for microbiome analysis. Microbiome composition and ecological metrics are compared to identify components influenced by the IBD-AID, and to separate bacterial 'enterotype' signatures of patients before, during and after diet intervention. We are currently recruiting patients.

Youth Outcomes of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in the Child Trauma Training Center (CTTC)

Fri, 03/03/2017 - 12:00pm

Objectives: Exposure to trauma among youth is common and can cause behavioral, social and functioning problems. Use of evidence-based trauma treatment can reduce post-traumatic stress (PTSD) symptoms and behavioral problems. This poster highlights the outcomes of youth who participated in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) provided by clinicians who were trained through the University of Massachusetts Medical School (UMMS) Child Trauma Training Center (CTTC).

Methods: 308 youth ages 6-18 were enrolled into the CTTC evaluation with a mean age of 11.31 years (SD = 3.5); over half were female (58.1%), the majority were white (62.3%) and 37% were Hispanic. Data was collected by clinicians at three different time points: baseline, six-months and discharge through REDCap using the following measures: Child Behavior Checklist (CBCL), UCLA PTSD Index and the Social Connectedness survey.

Results: The results of the UCLA PTSD Index indicated that youth experienced significantly fewer Re-experiencing (baseline [M = 9.67]; discharge [M = 6.36]), Avoidance/Numbing (baseline [M = 10.55]; discharge [M = 8.63], and Arousal symptoms (baseline [M = 11.46]; discharge [M = 9.02]), as well as less severe symptoms (baseline [M = 33.43]; discharge [M = 24.71]) overall. The CBCL revealed youth experienced fewer Internalizing (baseline [M = 64.51]; discharge [M = 62.18]), Externalizing (baseline [M = 64.51]; discharge [M = 62.18]) and total problem behaviors (baseline [M = 65.48]; discharge [M = 61.82]) overall compared to baseline. Additionally, youth reported significantly better change in Social Connectedness (M = 4.32) compared to baseline (M = 4.06).

Conclusion and Discussion: Results of the youth and parent/caregiver reports of PTSD symptoms, behavioral problems and social connectedness indicates that youth and parent/caregivers noticed significantly fewer and less severe PTSD symptoms, fewer behavioral problems and improvement in social connectedness compared to baseline. These results adequately show positive child outcomes as a result of TF-CBT treatment in the context of CTTC’s framework.

ALS Surveillance in Massachusetts: A one-of-a-kind registry for tracking an elusive disease

Fri, 03/03/2017 - 12:00pm

Background: Amyotrophic Lateral Sclerosis (ALS) is a progressive and fatal neuromuscular disease with an etiology not yet fully understood. The Massachusetts Argeo Paul Cellucci ALS Registry is a unique population-based surveillance system used to monitor the occurrence of ALS throughout the state and to explore possible environmental causes of the disease.

Methods: The Registry gathers annual reports of ALS cases from physicians, hospitals, and clinics in accordance with state regulations. Medical records are obtained and abstracted for each case, and eligible cases are reviewed by a consulting neurologist to confirm diagnosis. Necessary clinical and demographic information are recorded in a database and used by the Massachusetts Department of Public Health (MDPH) to prepare reports containing community-specific and statewide prevalence and incidence estimates. The data are also used to investigate spatial and temporal patterns and constitute a rich resource for researchers to explore environmental risk factors and whether they may impact disease rates.

Results and Conclusion: The result is a first-in-the-nation registry that allows for complete ascertainment of all reported cases. From 2007-2011, 826 new ALS cases were reported to MDPH. The age-adjusted incidence rate was 2.2 people per 100,000 per year, and the age-adjusted prevalence rate was 5.6 per 100,000 per year - both comparable to the range of estimates reported in scientific literature. MDPH evaluated ALS occurrence similarly by community and other variables like age and family history. Data are available to inform patient service needs and epidemiologic studies. Researchers can apply for access with the MDPH's IRB.

Raising Physician Awareness to Reduce Childhood Lead Exposure: The Massachusetts Community Lead Progress Report

Fri, 03/03/2017 - 12:00pm

Massachusetts has been at the forefront of childhood lead poisoning prevention, enacting one of the nation's first Lead Laws in the 1970's. The Massachusetts Lead Law is stringent, requiring universal screening of children for lead poisoning multiple times before age three, and the removal or covering of lead paint hazards in all homes built before 1978 where a child under age six lives. Owing to such a robust law, Massachusetts screening rates are high and the prevalence and incidence of lead poisoning has been steadily decreasing since 2000. Despite these successes, there is wide variation in screening and prevalence rates at the community level, with some communities showing a need for a more targeted approach. Additionally, scientific evidence increasingly suggests that even low levels of lead exposure cause severe and irreversible health effects, underlining the fact that lead remains a significant health risk for children in Massachusetts. To address these concerns, Massachusetts DPH has developed a direct mailing tool for physician outreach providing community-specific indicators of childhood lead screening and exposure and highlighting areas of needed improvement in screening, follow-up, and prevention. The Childhood Lead Poisoning Community Progress Report focuses on awareness of the CDC reference level of 5 µg/dL and the dangers of low-level lead exposure, educating medical providers on their role in preventing lead exposure by screening all children, following proper testing practices, and educating parents on available resources. Qualitative and quantitative approaches will be used to measure the impact of the Community Progress Report over time.

Connecting Community to Research: A Training Program to Increase Community Partnerships in Research

Fri, 03/03/2017 - 12:00pm

Background: Community Engaged Research (CEnR) as a means to address health disparities has emphasized the necessity for community members to partner with researchers. The Boston University CTSI identified the local need to increase the number and diversity of community members ready and willing to engage in the research process.

Methods: Connecting Community to Research (CCR) was designed to train community groups interested in improving the health of their community. Trainings were adapted from existing curricula with input from a 12 member advisory panel. The goal was to help trainees understand the various roles they can play along the research process. In a 1-2 hour training, participants were guided through an introduction to CEnR and learned how sharing their stories could inform research. The training concluded with an evaluation survey and opportunities to get connected to loco-regional projects.

Results: From December 2015 to November 2016, 100 participants of diverse backgrounds were trained at 7 sessions: 56% identified as White, 35% African American, and 6% other races. Evaluation data indicated: 94% of trainees understood how research could address a community concern, 82% understood how to use their stories to inform research, and 53% intended to participate as an advocate in research.

Conclusion: These data suggest trainings like CCR can increase the number and diversity of community members willing to engage in research. While this introductory training generated positive results, additional trainings with varying levels of skill development may be needed to further empower community members to engage as partners in research.

Comics and Medicine: Building Collections and Raising Awareness

Fri, 03/03/2017 - 12:00pm

Graphic medicine, or the use of comics in healthcare, is a growing field within medical humanities that is of particular interest to those concerned with health literacy and medical education. Currently, this field is being explored on several fronts at the Lamar Soutter Library in an effort to provide key resources for study and to build community awareness of the potential uses of comics in medicine. These efforts include a scoping review study funded by the Gold Foundation to determine how comics are currently used in medicine and to what effect; the creation of book club kits on specific medical topics - from cancer to PTSD to LGBTQ health - to be made available to the entire New England region; a growing collection of graphic novels available for borrowing from the library; outreach to area libraries, educators, and researchers who may be interested in the role comics can play in health literacy; the creation of book and citation lists for easy browsing; an ongoing effort to host speaking events with cartoonists and medical professionals engaged in graphic medicine; and an upcoming webinar to provide an overview of the field to any interested. In the future, we hope to partner with other community members to develop targeted comics to aid those in the community better understand their health.

Development of a Health Promotion Program: Targeting Adolescent Behaviors and Attitudes Toward Prescription Opioids

Fri, 03/03/2017 - 12:00pm

The current opioid epidemic kills an estimated four people every day in Massachusetts and is considered one of the greatest health threats to adolescents. Massachusetts state data indicates opioid addiction is a public health crisis, which requires the development of a health promotion program for adolescents and legislative action. The innovative eight-week middle school-based program Promote Opioid Prevention Program 4 Youth (POPPY) is implemented during Health and Wellness classes. POPPY is based on the Social Cognitive Theory, focusing on environmental and health behaviors. The goals of this distinct program are to: reduce adolescents' misuse of prescription opioid medication, increase adolescents' self-efficacy to make healthy decisions regarding misuse of prescription opioid medication, and to foster an environment conducive to preventing misuse of prescription opioid medication, while building social and self-management skills. The POPPY health promotion program will provide education that leads to development of health-related decision-making skills. Ultimately, healthier decisions lead to a reduction in opioid misuse risk factors such as peer pressure, social influence, curiosity, and experimentation. Protecting youth from health risks is critical to preventing fatalities associated with chronic conditions such as drug addiction that can lead to the onset of other major illnesses later-on in adulthood.

Sibling Support Program: A Family-Centered Mental Health Initiative

Fri, 03/03/2017 - 12:00pm

Sibling Support Program: A Family-Centered Mental Health Initiative was developed at the Eunice Kennedy Shriver Center of the University of Massachusetts Medical School. The project is currently implemented at Cambridge Health Alliance in Cambridge, Massachusetts as an IRB-approved research study, and at another Boston-based hospital as a Quality Improvement (QI) initiative. The program was also piloted at Boston Children's Hospital in Boston, Massachusetts. The project explores the impact of mental illness on typically developing siblings and caregivers of children with psychiatric needs. Project goals: to increase resiliency and mitigate the trauma commonly experienced by siblings of children admitted for psychiatric hospitalization; to build skills, competency and confidence among parents; to help restore family stability post-discharge; to build capacity among medical practitioners. Interventions include psycho-educational groups for caregivers, and sibling support groups for children growing up alongside the patient. Participants complete surveys following the intervention to report on knowledge learned, satisfaction level, and behavioral change anticipated by the participant. Over 1,500 participants have participated in this innovative program that utilizes parent mentors and medical trainees to deliver interventions, with high satisfaction scores among participants. Results suggest that a child's mental illness can be traumatic for family members, and that sharing stories can alleviate the stress and anxiety related to living in a home with a child with mental illness. The program serves as a training rotation for psychiatry residents through Harvard Medical School.

School Based Pediatric Asthma Surveillance in Massachusetts

Fri, 03/03/2017 - 12:00pm

Asthma remains one of the most common chronic diseases among children in the United States today. Surveillance is limited to national and state estimates which can vary over time and by population (CDC/NCHS, National Health Interview Survey, 2012). It is estimated that anywhere from 14% to 50% of children with asthma remain undiagnosed. The Massachusetts Department of Public Health's Bureau of Environmental Health (MDPH/BEH) has been conducting a successful and comprehensive statewide school-based asthma surveillance program since 2002. Partnering with school nurses throughout the state, we request aggregate information via a one-page survey. The survey is distributed to all public, private, charter and virtual schools in Massachusetts (n=1800). Variables collected include number of students with asthma by gender, grade (K-8), race/ethnicity and community of residence. Therefore, we can estimate prevalence by school and community. Now entering the 15th year, the program has a near 100% survey response rate. This successful surveillance effort reveals a statewide asthma prevalence of 12.4%, one of the highest rates in the nation and suggests approximately 85,000 students in Massachusetts carry the diagnosis. Furthermore, trends over the last 10 years of data collection indicate asthma to be higher among males than females for this age group (~5-14). School-based pediatric asthma surveillance demonstrates the important role school nurses play in surveillance. The feasibility of using school health records as a secondary data source will be highlighted as a reliable, aggregate, community-based source of data.