Justice involvement has a profound link to social determinants of health

Social determinants are strong predictors of a person’s health, those being employment, income, housing, food security and social inclusion. What are the outcomes, then, when one characteristic has downstream impact on all the determinants? I learned the answer at the 11th Academic and Health Policy Conference on Correctional Health in Houston on March 22, when leaders from the Association of American Medical Colleges (AAMC), the Academic Consortium on Criminal Justice Health(ACCJH) and JustLeadershipUSA discussed the impact of criminal justice involvement on the health of individuals and their families

Culture, language, and the doctor-patient relationship

BACKGROUND: This review\u27s goal was to determine how differences between physicians and patients in race, ethnicity and language influence the quality of the physician-patient relationship. METHODS: We performed a literature review to assess existing evidence for ethnic and racial disparities in the quality of doctor-patient communication and the doctor-patient relationship. RESULTS: We found consistent evidence that race, ethnicity; and language have substantial influence on the quality of the doctor-patient relationship. Minority patients, especially those not proficient in English, are less likely to engender empathic response from physicians, establish rapport with physicians, receive sufficient information, and be encouraged to participate in medical decision making. CONCLUSIONS: The literature calls for a more diverse physician work force since minority patients are more likely to choose minority physicians, to be more satisfied by language-concordant relationships, and to feel more connected and involved in decision making with racially concordant physicians. The literature upholds the recommendation for professional interpreters to bridge the gaps in access experienced by non-English speaking physicians. Further evidence supports the admonition that majority physicians need to be more effective in developing relationships and in their communication with ethnic and racial minority patients

Training Faculty for Cultural Teaching

Learning Objectives: Following the completion of this chapter, the reader should be able to: (1) Describe several potential rationales for faculty development in cultural competency; (2) Understand a model for ascertaining levels of student knowledge, skills and attitudes regarding cultural competency; (3) Plan a one-on-one teaching encounter on cultural competency using three distinct teaching methods; (4) Consider other teaching methodologies such as video vignettes, small group facilitation, role play and community immersion for cultural competency training; (5) Understand the elements of formative feedback that may be particularly relevant to this work

Strategies for Reducing Adverse Outcomes for Criminal Justice-Involved Populations

In the United States, we spend $81 billion taxpayer dollars annually on the costs of incarceration according to the Bureau of Justice Statistics, but including other costs may increase that estimate to$181 billion. Data from Worcester suggest that the cost of incarcerating individuals in the Piedmont neighborhood of Worcester eclipse the entire annual budget of the Division of Public Health in Worcester. With a hard line on petty crime, lack of substance use disorder treatment in jail and prison, concentrated policing and racial profiling in low income communities of color and poor reentry support services, mass incarceration is destined to continue. The opioid crisis in Massachusetts has affirmed that individuals with a history of incarceration and opioid use disorder are at greatest risk for nonfatal and fatal overdose. Furthermore, homelessness and serious mental illness increase that risk dramatically. In turn, the Governor and Secretary of Health and Human Services in concert with the Massachusetts Medicaid Program, the Department of Public Health and the Trial courts have undertaken a multi-pronged strategy to mitigate those risks. This panel will present three interventions to improve those outcomes. Three panelists will describe and present findings on three studies completed and in process to reduce the health risks for justice-involved persons in Massachusetts. Dr. Ferguson will describe an implementation science study of four correctional systems which embarked on medication assisted therapies for opioid use disorder which has helped to inform current mixed methods research to study a pilot of medication assisted treatment in seven Massachusetts jails; Dr. Pivovarova will describe her study of health status for individuals participating in Drug Court, a diversionary program that mandates substance use disorder treatment in the community for individuals arrested for drug related offenses; and Ms. Dupuis will describe the MassHealth funded Behavioral Health Justice Involved project to provide returning citizens with navigators to assist them in linking to community-based treatment and to address social determinants of health such as housing and employment. During the presentations, attendees will be asked to formulate questions or reflections for discussion. These will be collected and prioritized by the moderator of the session for further discussion

The academic and health policy conference on correctional health: evaluation of its academic and scientific impact

Background: There is limited research and research dissemination on the care of detained persons, often due to barriers to conducting research in correctional settings. Additionally, while concerns exist about the quality of care delivered to inmates, only a small number of academic health science centers provide health care services behind bars. To strengthen the field of academic criminal justice health (ACJH), the Academic and Health Policy Conference on Correctional Health (AHPCCH) was launched in 2007. Objective: To assess the merits of the conference as a stimulus to advance the field of ACJH. Methods: Two hundred ninety-one individuals were identified who had presented at the AHPCCH and/or had received a conference attendance scholarship between 2011 and 2013. A web-based survey assessed: networking opportunities; motivation to disseminate or continue in this field; scholarly outputs; clinical practice changes; clinical guidelines development; curriculum/training opportunities; and a climate assessment at participant’s home institution in support of their work. Results: With a 56 % response rate, the majority felt that the conference: provided encouragement and confidence to continue their work; validated their identity as a contributor in the field; and provided valuable feedback on their work. 86 % reported that the conference provided numerous networking opportunities. Most respondents reported that the conference provided new ideas for research and/or academic efforts and 62 % reported motivation to expand their scholarly work. Most also indicated that their choice to work in criminal justice health was respected at their home institution, with 64 % identifying collaborators with similar content interest/expertise and 66 % reporting opportunities to advance available as a result of their work. However, 70 % do not receive institutional funding during periods when their own extramural funding is low and 59 % were not part of an ACJH research core. Conclusions: The majority of presenters and scholars felt that the conference fulfilled professional development opportunities needed in the field. Moreover, the conference generated new ideas for research and/or academic efforts. Thus, the AHPCCH is a valuable opportunity for researchers, policymakers and clinicians to network, share and improve upon their work, generate research ideas and, ultimately, validate criminal justice health as an academic field of study

A Randomized Controlled Trial of Community Health Workers Using Patient Stories to Support Hypertension Management: Preliminary Results

Background: Uncontrolled hypertension is a significant public health problem in the U.S. with about one half of people able to keep blood pressure under control. Furthermore, the social and economic costs of poor hypertension control are staggering. Community Health Worker (CHW) interventions are a low-cost, culturally tailored approach to improve chronic disease outcomes. Methods: This randomized trial conducted at two Community Health Centers (CHCs) in Massachusetts assessed the effect of CHWs assisting patients with hypertension. CHWs, trained in motivational interviewing, used video narratives from patients who have worked to control their BP through diet, exercise, and better medication adherence. Participants enrolled in the study were randomly assigned to immediate intervention or a delayed intervention (DI) (4 to 6 months later). Each participant received a DVD and met with a CHW 5 times (twice in person and three times telephonically) over six months. Results: One hundred seventy-one patients were randomly assigned to one of two treatment conditions. Participants ranged in age from 25 to 79 years old (mean = 56 years old). Seventy-three percent of participants were Hispanic and reported speaking Spanish at home. The intervention group experienced a significant reduction in BP over the 6 month period of time they were receiving the intervention. At 6 months, the average systolic BP declined from 141 at baseline to 136 (p Discussion: Having culturally appropriate tools, such as narrative videos and CHWs trained in motivational interviewing, can be an important, cost effective aid to educate, support, and encourage people to manage hypertension

Lessons Learned From a Collaborative to Improve Care for Patients With Diabetes in 17 Community Health Centers, Massachusetts, 2006

INTRODUCTION: In 2006, the Massachusetts League of Community Health Centers convened a collaborative to systematically improve health care delivery for patients with diabetes in 17 community health centers. Our goal was to identify facilitators of and barriers to success reported by teams that participated in this collaborative. METHODS: The collaborative\u27s activities lasted 13 months. At their conclusion, we interviewed participating team members. We asked about their teams\u27 successes, challenges, and take-home messages for future collaborative efforts. We organized their responses into common themes by using the Chronic Care Model as a framework. RESULTS: Themes that emerged as facilitators of success included shifting clinic focus to more actively involve patients and to promote their self-management; improving the understanding and implementation of professional guidelines; and expanding staff roles to accommodate these goals. Patient registries were perceived as beneficial but lacking adequate technical support. Other barriers were staffing and time constraints. CONCLUSION: Cooperative efforts to improve health care delivery for people with diabetes may benefit from educating the health care team about guidelines, establishing a stronger role for the patient as part of the health care team, and providing adequate technical instruction and support for the use of clinical databases

Community dimensions and HPSA practice location: 30 years of family medicine training

BACKGROUND AND OBJECTIVES: Our objective was to assess practicing family physicians\u27 confidence and participation in a range of community-related activities. Additionally, we assessed the strength of the relationship between the physicians\u27 reported medical school and residency training in community-related activities and their current community activities, as well as whether they were practicing in an underserved location. METHODS: All 347 graduates of the University of Massachusetts Family Medicine Residency were surveyed about practice location and type, involvement and training in community work, confidence in community-related skills, and sociodemographic characteristics. Analyses were conducted by residency graduation decade (1976-1985, 1986-1995, and 1996-2005). RESULTS: Earlier graduates (19761985) were significantly more likely to engage in an array of community-related activities, but recent graduates (1996-2005) were more likely to report having been trained in these skills. There was a significant positive association between practice in an underserved area and confidence in issues related to sociocultural aspects of care. While recent graduates were more likely to locate both initial and current practices in a Health Professions Shortage Area (HPSA), 20.6% of all graduates reported an initial practice in a HPSA. CONCLUSIONS: While family physician involvement in community-related activities increases with years out of residency, a higher proportion of recent graduates report having learned community-related skills while in medical school. Physician relocation tends to be away from HPSA toward non-HPSA sites

Recruitment and Retention of Community Health Center Primary Care Physicians post MA Health Care Reform: 2008 vs. 2013 Physician Surveys

OBJECTIVES: In 2008 and 2013, the University of Massachusetts Medical School and the Massachusetts League of Community Health Centers surveyed community health center (CHC) primary care physicians (PCPs) to identify factors related to preparedness, recruitment and retention. The survey was repeated to determine the impact of Massachusetts health care reform. METHODS: An online survey was sent to 677 PCPs at 46 CHCs. New questions addressed patient-centered redesign, language competencies, and interprofessional care. ESULTS: With 48% responding, PCPs were significantly more prepared in 2013 to practice in a CHC. Intent to continue practicing in a CHC was related to age, length of time in practice, language skills, teaching, research, compensation, model of care, professional development, and practice goals. CONCLUSIONS: Outcomes illustrate opportunities to prepare medical students and residents for CHC careers and recruit and retain this vital workforce. Retention efforts must include teaching, administration, research, and professional development opportunities

Family medicine residency characteristics associated with practice in a health professions shortage area

BACKGROUND AND OBJECTIVES: While some family medicine residency programs are designed to train residents in community health centers (CHCs) for future careers serving underserved populations, there are few outcome studies on such programs. Our residency program provides three options for ambulatory health center training, but otherwise residents participate in the same curriculum. We analyzed relationships between ambulatory training site and likelihood of practice in health professions shortage areas (HPSAs). METHODS: We sent a mail survey to all graduates of one family medicine residency about practice locations, types, and populations; influences on practice choice; and sociodemographic characteristics. RESULTS: Training in a CHC had a statistically significant association with the likelihood of practice in an HPSA for both initial and current practice. Training in a rural residency site was associated with initial and current rural practice. Logistic regression analysis showed that physicians who completed ambulatory training in the CHC were nearly six times more likely to report having practiced initially and four times more likely to cite current practice in an HPSA. CONCLUSIONS: Outpatient CHC residency training increases the likelihood of practice in an underserved setting. This finding has policy implications for supporting workforce training in practice settings that care for underserved populations