>> MY NAME IS
MARRAH LACHOWICZ SCROGGINS,
PROGRAM DIRECTOR AT THE NATIONAL
HEART LUNG AND BLOOD INSTITUTE.
I ALSO SERVE AS THE INSTITUTE
CO-CHAIR FOR WOMEN'S HEALTH
WORKING GROUP.
ON BEHALF OF A TRANS-NIH
ORGANIZING COMMITTEE FOR THIS
WORKSHOP, I WOULD LIKE TO EXTEND
WELCOME TO ALL ATTENDEES WHO
WILL JOIN TODAY FOR THE BUILDING
UNIFYING SYSTEMS OF CARE
ADDRESSING CO-MORBIDITIES IN
WOMEN AND GIRLS WORKSHOP
SPONSORED BY THE NATIONAL HEART
LUNG AND BLOOD INSTITUTE.
THE PURPOSE OF THE WORK SHOP IS
TO ADDRESS THE NEED TO DEVELOP
SUPPORT CONTINUUMS OF CARE WHICH
WOULD ADVANCE HEALTH OF RACIAL
ETHNIC DIVERSE WOMEN OF
REPRODUCTIVE AGE WITH COMPLEX
HEALTH CONDITIONS.
TO ACHIEVE THIS GOAL THIS
WORKSHOP WILL ADDRESS CURRENT
GAPS AND OPPORTUNITIES TO
IMPLEMENTING COMMUNITY ENGAGE
RESEARCH DESEENED TO INCREASE
ADOPTION OF INTEGRATED SET OF
EVIDENCE BASED PRACTICES
DELIVERED AID CROSS HEALTHCARE
SYSTEMS INCLUDING PRIMARY
SPECIALTY BEHAVIORAL HEALTH AND
COMMUNITY HEALTH BASED SETTINGS.
THE WORKSHOP PLANNING COMMITTEE
INCLUDES TWO WORKSHOP CO-CHAIRS
DR. CHANDER AND DR. JOHNSON,
ALONG WITH A TRANS-NIH
ORGANIZING COMMITTEE WHO ARE
MEMBERS OF A TRANS-NIH WORKING
GROUP ON ADDRESSING COMMON
CO-MORBIDITIES IN WOMEN AND
GIRLS.
THESE INCLUDE DR. LAURIE DONZE
FROM NHLBI DR. TAMARA JOHNSON,
DR. DEIDRE ROACH FROM NIAAA AND
DR. SMITH AND HOLLY MOORE FROM
NIDA.
YOU CAN SUBMIT QUESTIONS DURING
THE Q&A MODULE DURING THE
WORKSHOP TO ENGAGE ANY
PRESENTERS AND MEMBERS OF THE
PLANNING COMMITTEE WILL
FACILITATE CONVERSATION
THROUGHOUT THE WORKSHOP AND MANY
OF THEM WILL ALSO BE MODERATING
TODAY'S SESSIONS.
THE CO-CHAIRS WILL LEAD THE
WORKSHOP CLOSE OUT SESSION LATER
TODAY WHERE THE GROUP WILL
DISCUSS ANY REMAINING GRANT --
GAPS IN HEALTHCARE DELIVERY
SYSTEM, AND HOW WE CAN BE
LEVERAGING VARIOUS OPPORTUNITIES
TO REPRODUCTIVE TRANSITION
PERIOD, TO IMPLEMENT EVIDENCE
BASED PRACTICES THAT WILL
FACILITATE THE DELIVERY OF AN
INTEGRATIVE INTERVENTION THAT
ADDRESS INTERSEXUALITY OF COMMON
CO-OCCURRING CONDITIONS IN WOMEN
AND ALSO ADDRESS RACIAL ETHNIC
DISPARITIES AND ENGAGEMENT
RECEIPT AND RETENTION IN CARE
AND TREATMENT AMONG HISTORICALLY
MARGINALIZED WOMEN WITH THESE
CO-MORBIDITIES.
NOW I AM GOING TO TURN THIS
WORKSHOP OVER TO OUR TWO
CO-CHAIRS, DR. CHANDER AND
JOHNSON TO GIVE A BRIEF RECAP OF
THE MEETING YESTERDAY BEFORE WE
START SESSION 4 OF THE WORKSHOP.
THANK YOU.
>> GOOD MORNING.
THANKS, EVERYONE FOR JOINING US
YESTERDAY.
WE HAD A NUMBER OF FANTASTIC
PRESENTATIONS THAT WE BRIEFLY
WANTED TO RECAP.
SO THOUGH EXISTING PRIOR TO
PANDEMIC WHAT WAS CLEAR
YESTERDAY AND I THINK CLEAR TO
ALL OF US IS NEVER MORE THAN
EVER HAVE HARMS OF OUR
FRAGMENTED SYSTEM BEEN MORE
SALIENT, A PARTICULARLY AMONG
WOMEN AND GIRLS.
SILOED SYSTEMS WITH DISEASE
BASED MODELS DO NOT RECOGNIZE
OVERLAP OF MULTIPLE CHRONIC
CONDITIONS AND THE TOLL THEY CAN
TAKE WHEN NOT RECOGNIZED AS
INTERACTING OR LINKED.
AS NOTED IN THE KEYNOTE BY DR.
SIMON THIS FRAGMENTED SYSTEM
OPERATES WITHIN THE CONTEXT OF
LARGE INEQUITIES, THAT MUST BE
ADDRESSED ACROSS HEALTH SYSTEMS
WITHIN RESEARCH AND AMONG POLICY
MAKERS AND IS NOTED BY DR. WILK,
PAYMENT REFORM WHEREBY
INCENTIVES NEED TO BE ALIGNED IN
SESSION TWO WE DISCUSSED
INTEGRATED MODELS OF CARE FOR
WOMEN IN PREGNANCY FROM CLINICAL
DECISION SUPPORT TO SUBSTANCE
USE DISORDERS, COMPUTER
DELIVERED INTERVENTIONS THAT
ALLOW UNIFORM SCREENING AND
DELIVERY FOR SUBSTANCE USE AMONG
WOMEN EVEN NOT SEEKING TREATMENT
TO UNIFORM DELIVERY OF
POSTPARTUM CARE THROUGH THE ROSE
INTERVENTION DESCRIBED BY DR.
JOHNSON, THAT DESTIGMATIZING
POST PARTEM DEPRESSION THROUGH
UNIVERSAL ACCESS.
TECHNOLOGY REALLY CAN BE
LEVERAGED TO DERIVE MIGRATION OF
PREGNANCY CARE AND PROMOTE
INTEGRATION WITHIN COMMUNITY
RESOURCES.
I THINK VERY RELEVANT TO OUR
DISCUSSION ARE DR. JOHNSON'S
NOTES THAT REALLY LOW INCOME
WOMEN ARE OFTEN NOT
APPROPRIATELY RESOURCED FOR
COORDINATING CARE TRANSITION.
AND SO THEY FALL OUT OF CARE.
AND WE NEED TO BE THINKING ABOUT
SYSTEMS AND REIMBURSEMENT
CHALLENGES AND CONSIDER TASK
SHIFTING AND THINK THROUGH HOW
POLICY CHANGES CAN BE USED TO
FACILITATE CARE INTEGRATION.
FINALLY DURING SESSION THREE WE
DISCUSSED IMPLEMENTING ESSENTIAL
COMPONENTS OF INTEGRATED HEALTH
SYSTEMS FOR WOMEN AND GIRLS AND
DISCUSSED SOME OF THE CHALLENGES
AND SUCCESSES.
WE DISCUSSED A NEW PARADIGM
WHICH INCLUDES MIND BODY
PRACTICES TO COMBAT STRESS AND
ENHANCE RESILIENCY.
NOTING SOME OF THE BARRIERS TO
INTEGRATIVE MEDICINE DR.
FIECHTNER DESCRIBED CONNECT FOR
HEALTH A TRANSLATIONAL
INTERVENTION TO ADDRESS
CHILDHOOD OBESITY.
WHERE HEALTHY WEIGHT CLINIC
PARTICIPATION DECREASED BODY
MASS INDEX AND WAS LINKED TO
IMPROVEMENTS IN HEALTHY
LIFESTYLES AND BEHAVIORS.
PERHAPS VERY INTERESTINGLY
IMPORTANTLY NATIONAL
IMPLEMENTATION WOULD EQUATE TO
9.2 MILLION IN HEALTHCARE COSTS.
OVER TEN YEARS.
DR. MASINTER DESCRIBED PREGNANCY
COMPLICATIONS LINKED TO PCP BY
SIX MONTHS.
MAJOR ISSUE OF MORBIDITY AND
MORTALITY AND SHE FOUND THAT
THOUGH MANY INDIVIDUALS DIDN'T
MAKE TRANSITION TO PRIMARY CARE
EVEN AMONG HIGH RISK PATIENT,
THIS IS INSURANCE LOSS, AND
OTHER ISSUES SO THEY ARE
PLANNING A QI INITIATIVE, TO
WORK THROUGH THIS.
AND FINALLY DR. CHAMBERS
DISCUSSED A MODEL CONTINUUM OF
CARE IN INDIGENOUS COMMUNITIES.
THAT USES CBPR COMMUNITY BASED
PARTICIPATORY RESEARCH AND
COMMUNITY HEALTH WORKERS TO
INTERVENE ACROSS THE LIFE SPAN.
SO AS YOU CAN SEE WE HAS A
COMPREHENSIVE AND RICH
DISCUSSION AND NUMBER OF
PRESENTATIONS YESTERDAY.
TODAY WE ARE GOING TO CONTINUE
THIS DISCUSSION AS WE MOVE ON TO
DISCUSS CURRENT MODELS THAT ARE
BEING TESTED AND USED AND
FINALLY THINKING ABOUT HOW TO
BUILD INFRASTRUCTURE FOR
INTEGRATIVE HEALTHCARE SYSTEMS
FOR WOMEN AND GIRLS.
WITH THAT I WILL PASS THIS ON
OVER.
>> THANK YOU FOR THAT WONDERFUL
SUMMARY.
NEXT WE'LL START WITH OUR
SESSION FOUR WHICH IS TITLED,
SAMPLING OF ACTUAL MODELS OF
CONTINUUMS OF CARE CHALLENGES
AND SUCCESSES, THIS IS GOING TO
BE A CONTINUATION OF THE SESSION
THREE WE HAD YESTERDAY WITH
ADDITIONAL NEW MODELS WE WANT TO
CONSIDER THEIR UTILITY AND SEE
WHAT WE CAN LEARN FROM THEM.
THIS SESSION WILL BE MODERATED
BY DR. KEESHA HIGHSMITH.
>> THANK YOU SO MUCH, GOOD
MORNING.
IT IS MY PLEASURE TO MODERATE
THIS SESSION.
THIS SESSION WILL BE STRUCTURED
SIMILAR TO THE OTHER SESSIONS
FROM YESTERDAY.
I WILL INTRODUCE THE PANELISTS
AT THE BEGINNING OF THE SESSION,
EACH PRESENTER WILL PRESENT
THEIR MODEL OF CARE AND KEY TAKE
AWAYS FOLLOWED BY A PANEL
DISCUSSION, DURING THE
PRESENTATIONS PLEASE FEEL FREE
TO ENTER YOUR QUESTIONS IN THE
Q&A BOX AT THE BOTTOM OF THE
SCREEN WE WILL ASK QUESTIONS
DURING THE PANEL DISCUSSION OR
IN SOME CASES PANELISTS MAY
INCLUDE A WRITTEN RESPONSE IN
THE Q&A BOX.
NOW THE ESTEEMED PANELISTS THE
FIRST IS DR. GEETANJALI CHANDER,
PROFESSOR OF MEDICINE AND
EPIDEMIOLOGY AT THE JOHNS
HOPKINS UNIVERSITY ASSOCIATE
DIRECTOR FOR THE JOHNS HOPKINS
PROGRAM FOR HIV OUTCOMES
RESEARCH.
AND THE RESEARCH DIRECTER FOR
JOHNS HOPKINS CENTER FOR
ADVANCE.
OF COMMUNITY CARE.
HER WORK SPANS EPIDEMIOLOGY,
CLINICAL TRIALS AND
IMPLEMENTATION RESEARCH FOCUS
INTERSECTION OF HIV RISK, HIV
INFECTION, AND UNHEALTHY ALCOHOL
USE.
SHE HAS A PARTICULAR INTEREST IN
ALCOHOL REDUCTION INTERVENTIONS
FOR WOMEN WITH AND AT RISK FOR
HIV INFECTION IN BALTIMORE CITY.
OUR NEXT PANELIST IS DR. SHERRY
MCKEE.
DR. MCKEE IS A PROFESSOR OF
PSYCHIATRY AT YALE SCHOOL OF
MEDICINE, WHERE SHE IS THE
FOUNDER AND DIRECTOR OF YALE
BEHAVIORAL PHARMACOLOGY
LABORATORY.
AND THE CLINICAL DIRECTOR OF
FORENSIC DRUG DIVERSION CLINIC.
DR. MCKEE'S RESEARCH OVER THE
PAST 20 YEARS HAS BEEN DIRECTED
AT DEVELOPING EFFECTIVE
TREATMENTS FOR ADDICTION WITH A
PARTICULAR FOCUS ON WOMEN AND
MORE RESENTLY CRIMINAL JUSTICE
POPULATIONS.
HER TRANSLATIONAL WORK SPANS
HUMAN LABORATORY PARADIGMS,
CLINICAL TRIALS, SURVEY RESEARCH
AND EPIDEMIOLOGICAL RESEARCH TO
UNCOVER THE MECHANISMS
UNDERLYING POOR OUTCOMES AND
TRANSLATE FINDINGS INTO IMPROVED
INTERVENTIONS FOR WOMEN AND MEN.
OUR THIRD PANELIST IS DR. FAYE
TAXMAN.
DR. TAXMAN IS A UNIVERSITY
PROFESSOR AT THE CHAR SCHOOL
POLICY GOVERNMENT AT GEORGE
MASON UNIVERSITY.
SHE IS A HEALTH SERVICE
CRIMINOLOGY.
SHE'S RECOGNIZED FOR SEAMLESS
SYSTEMS OF CARE MODEL AND LINKED
THE CRIMINAL JUSTICE SYSTEM WITH
OTHER HEALTHCARE AND SERVICE
DELIVERY SYSTEMS AND FOR
RE-ENGINEERING PROBATION AND
PAROLE SUPERVISION SERVICES.
SHE CONDUCTED EXPERIMENTS TO
EXAMINE DIFFERENT PROCESSES TO
IMPROVE TREATMENT ACCESS AN
RETENTION TO ASSESS NEW MODELS
OF PROBATION SUPERVISION,
CONSISTENT WITH THE RISK NEED
RESPONSIVITY FRAME WORKS AND TO
TEST NEW INTERVENTIONS.
SO I WILL NOW TURN IT BACK OVER
TO DR. CHANDER TO START HER
PRESENTATION.
THANK YOU FOR THAT LOVELY
INTRODUCTION.
TODAY I WILL TALK ABOUT A
PROJECT THAT WE HAVE BEEN DOING
THAT USES COMMUNITY BASED
PARTICIPATORY RESEARCH TO
ADDRESS ALCOHOL USE AND OTHER
CO-MORBIDITIES ACROSS THE HIV
PREVENTION AND CARE CONTINUE
WOMB, IT IS IMPORTANT TO
ACKNOWLEDGE DR. HEIDI HUTTON, MY
PARTNER IN THIS WORK AND AT THE
END I WILL ALSO RECOGNIZE OUR
COMMUNITY ADVISORY BOARD.
NEARLY HALF OF ALL WOMEN REPORT
ANY ALCOHOL USE IN THE PAST ONE
MONTH IN THE UNITED STATES WITH
12% OF WOMEN REPORTING HEAVY
EPISODIC DRINKING THREE TIMES
PER MONTH WITH AN AVERAGE OF
FIVE DRINKS PER DRINKING
EPISODE.
AND IN 2019, 4% WOMEN MET
CRITERIA FOR PAST USE ALCOHOL
USE KISS ORDER PAST YEAR ALCOHOL
USE DISORDER.
WOMEN EXPERIENCE AD VERSION
EFFECTS OF ALCOHOL USE AT LOWER
LEVELS.
THIS IS DUE TO DIFFERENCES IN
BODY WATER, DIFFERENCES IN
ALCOHOL DEHYDROGENASE, AND AT
LOWER LEVELS OF ALCOHOL USE
WOMEN HAVE INCREASED IMPAIRMENT
WHICH CAN RESULT IN HANG OVERS
BLACKOUTS, AND CAN ALSO RESULT
IN ALCOHOL RELATED ILLNESSES
INCLUDING LIVER DISEASE,
NEUROLOGICAL CONDITIONS, CARDIAC
DISEASE, AFTER SHORTER PERIOD OF
DRINKING COMPARED TO MEN AND I
THINK AS NOTED AMONG MANY
PRESENTATION, ALCOHOL USE AMONG
WOMEN CAN BE CO-MORBID WITH
OTHER SUBSTANCE USE AND MENTAL
HEALTH KISS ORDERS INCLUDING
ANXIETY DEPRESSIONND AND TRAUMA
WHICH ARE MORE PREVALENT AMONG
WOMEN WITH ALCOHOL USE
DISORDERS, OTHER SUBSTANCE USE
IS ASSOCIATED WITH ALCOHOL USE
AND ALSO ASSOCIATED WITH
VIOLENCE AND INTIMATE PARTNER
VIOLENCE.
ALCOHOL USE CONTRIBUTE
SIGNIFICANTLY TO HIV RISK AMONG
WOMEN AND INCLUDING DECREASE
CONDOM USE AND CONDOM
NEGOTIATION, INCREASE SEXUAL
RISK BEHAVIORS, MANY UNINTENDED
CONSEQUENCES AMONG WOMEN
INCLUDING SEX WITH NEW PARTNERS
OR CONDOMLESS SEX AND AMONG
WOMEN WITH HIV UNHEALTHY ALCOHOL
USE IS ASSOCIATED WITH LOWER
ADHERENCE TO ANTI-REROW VIRAL
THERAPY, LOWER DURABLE VIRAL
SUPPRESSION, AND INCREASE
TRANSMISSION RISK BEHAVIORS.
IN THE UNITED STATES MOST RECENT
DATA REFLECT THERE WERE 37,968
NEW DIAGNOSES IN THE UNITED
STATES OF THOSE 19% WERE AMONG
WOMEN AND IT IS ALWAYS I THINK
SO OFTEN WHEN WE THINK OF HIV
INFECTION WE DON'T THINK OF
WOMEN WHO ARE BEING INFECTED BUT
19% IS A FAIR NUMBER.
MOST NEW HIV DIAGNOSES ARE
ATTRIBUTED TO HETEROSEXUAL
CONTACT, 85%.
WITH THAT CONTEXT IN MIND I WANT
TO PRESENT DATA FROM A STUDY
DONE BY DR. HUTTON.
IN THE BALTIMORE CITY HEALTH
DEPARTMENT STI CLINICS.
AMONG 671 STI ATTENDEES THAT
WERE ATTENDED -- TESTED FOR
GONORRHEA, AND UNDERWENT
CONCURRENT QUERYING SUBSTANCE
USE AND SEXUAL RISK BEHAVIORS,
21% RECORDING SEX WHILE UNDER
INFLUENCE OF ALCOHOL, 30% WOMEN
REPORTED HEAVY EPISODIC DRINKING
COMPARED TO 42% IN MEN AND
IMPORTANTLY WOMEN WITH HEAVY
EPISODIC DRINKING ENGAGED AT
ANAL SEX TWICE THE RATE OF WOMEN
AND THREE TIMES THE AMOUNT OF
WOMEN WHO ABSTAINED.
LIKELY TO HAVE MULTIPLE SEX
PARTNERS AND GONORRHEA WAS FIVE
TIMES HIGHER WITH HEAVY EPISODIC
DRINKING.
THESE DATA REFLECT THE RISK THAT
CAN OCCUR WITH ALCOHOL USE?
THE CONTEXT OF SEX.
HERE I PRESENT BASELINE DATA
FROM A CLINICAL TRIAL WE DID
WHERE WE TESTED A COMPUTER
DELIVERED INTERVENTION IN THE
STI CLINICS.
I'M NOT GOING TO REVIEW THE
STUDY, BUT WHAT I WANT TO DO IS
POINT OUT THE BASELINE DATA.
SO WHAT WE FOUND WAS THAT AMONG
439 WOMEN IN THE TRIAL, 65% HAD
CONCURRENT SUBSTANCE USE.
CLOSE TO 30% HAD CURRENT PANIC
SYMPTOMS, 37% CURRENT PTSD
SYMPTOMS, AND I THINK REALLY
MOST IMPORTANTLY, TWO-THIRDS OF
THE WOMEN IN THIS SAMPLE HAD AN
ALCOHOL USE DISORDER.
WE WERE SURPRISED BY THIS, WE
HAVE NOVEMBE NOT EXPECTED HIGH RATES OF
MODERATE TO SEVERE ALCOHOL USE
DISORDER.
WE WERE INTERESTED TO REALLY TRY
AND LOOK AT THE CHARACTERISTICS
OF WOMEN WHO WERE COMING INTO
THE CLINIC WITH ALCOHOL USE
DISORDER BECAUSE WE WERE SO
SURPRISED.
NOT SURPRISINGLY THEY WERE MORE
LIKELY TO HAVE CONCURRENT
SUBSTANCE USE INCLUDING
MARIJUANA, COCAINE AND OPIOID
USE.
WE ALSO LOOK AT CO-MORBIDITIES
AMONG WOMEN WITH ALCOHOL USE
DISORDER AND AGAIN I THINK NONE
OF US ARE SURPRISED BY THE FAR
HIGHER PREVALENCE OF PTSD
SYMPTOMS AMONG WOMEN WITH
ALCOHOL USE DISORDER VERSUS
WITHOUT.
DEPRESSIVE SYMPTOMS, GENERALIZE
ANXIETY SYMPTOMS AND A FAR
HIGHER PREVALENCE OF CUMULATIVE
MENTAL HEALTH DISORDERS.
MOVING ACROSS THE HIV PREVENTION
AND CARE CONTINUUM, NOW WE
TALKED A LITTLE BIT ABOUT HIV
RISK AND NOW LET'S TALK ABOUT
HIV, COMPARED TO ALL WOMEN, ALL
PEOPLE DIAGNOSE WITH HIV, WOMEN
HAVE LOWER VIRAL SUPPRESSION,
76% OF WOMEN WITH HIV RECEIVED
SOME CARE, 58% RETAINED IN CARE,
AND 63% WERE VIRAL LOGICALLY
SUPPRESSED.
THESE ARE UNPUBLISHED DATA FROM
THE JOHNS HOPKINS HIV CLINICAL
COHORT WHERE WE DID OVER 1700
COMPUTERS ASSISTED INTERVIEWS
AMONG 600 WOMEN, 36% REPORTED
CURRENT ALCOHOL USE, AND 43% MET
CRITERIA FOR UNHEALTHY ALCOHOL
USE ON THE AUDIT C AND WOMEN WHO
DRANK WERE TWICE AS LIKELY TO
REPORT DEPRESSIVE SYMPTOMS AND
TRAUMA SYMPTOMS.
THEY WERE ALSO LESS LIKELY TO
REPORT GREATER THAN 90%
ADHERENCE AND LESS LIKELY TO BE
VIRAL LOGICALLY SUPPRESSED.
I WILL QUICKLY RUN THROUGH THESE
DATA SO I DON'T GO OVER TIME.
BECAUSE I HAVE MORE TO TALK
ABOUT.
WE DID STRUCTURED CLINICAL
DIAGNOSTIC INTERVIEWS AMONG
WOMEN IN THE CLINIC, JOHNS
HOPKINS HIV CLINIC AND FOUND
VERY, VERY HIGH PREVALENCE OF
LIFETIME MENTAL HEALTH DISORDERS
AND IN TERMS OF LIFETIME PTSD,
35% CURRENT PTSD, ABOUT 17%.
LIFETIME PANIC WAS ALSO HIGH AS
MAJOR DEPRESSION.
SO I SHOW THESE DATA REALLY
DEMONSTRATE THAT WE CAN'T REALLY
THINK ABOUT ALCOHOL USE AMONG
WOMEN WITHOUT THINKING ABOUT
OTHER CO-MORBID CONDITIONS.
AND THOSE INCLUDE OTHER MENTAL
HEALTH DISORDERS, OTHER
SUBSTANCE USE DISORDERS IN
ADDITION TO CHRONIC DISEASES
SUCH AS HIV.
SO UNHEALTHY ALCOHOL USE OCCURS
WITHIN THIS CONTEXT OF
CO-MORBIDITIES AND OTHER
DETERMINANTS, AND THERE IS
REALLY A NEED FOR INTEGRATED
INTERVENTIONS THAT ADDRESS
ALCOHOL USE IN THE CONTEXT OF
MENTAL HEALTH AND SUBSTANCE USE
CO-MORBIDITY AND REPRODUCTIVE
HEALTH.
FAILING THAT GOAL WE NEED TO
INCREASE COORDINATION OF CARE
BETWEEN AGENCIES THAT PROVIDE
THESE DIE LOAD SERVICES AND
INCREASE PUBLIC AWARENESS OF
TREATMENT RESOURCES.
AS SUCH WE HAVE LOOKED AT ALL
THESE DATA AND SAID WE NEED
PROGRAMS TAILORED TO WOMEN THAT
ADDRESS REPRODUCTIVE HEALTH,
ALCOHOL EXPOSED PREGNANCIES,
CHILD CARE FAMILY CARE, HIV
STIGMA ALCOHOL USE MENTAL HEALTH
DISORDERS.
WE DEVELOPED A PROGRAM CALLED
SHARP WOMEN.
CHAMP WOMEN IS A COMMUNITY BASED
PARTICIPATORY RESEARCH PROJECT
FUNDED BY NIAAA U-34 IN CBPR WE
ADDRESS SOCIAL STRUCTURAL AND
PHYSICAL ENVIRONMENTAL
INEQUITIES THROUGH ACTIVE
INVOLVEMENT OF COMMUNITIES
MEMBERS ORGANIZATIONAL
REPRESENTATIVES AND RESEARCHERS
IN ALL ASPECTS OF THE RESEARCH
PROCESS.
PARTNERS CONTRIBUTE EXPERTISE TO
ENHANCE UNDERSTANDING OF A GIVEN
PHENOMENA AND INTEGRATE
KNOWLEDGE THEY NEED WITH ACTION
TO BENEFIT THE COMMUNITY
INVOLVED.
PRIOR TO GRANT SUBMISSION AND
CO-DEVELOPED AIMS WHAT WE GOT
OUT OF OUR MEETINGS WAS THAT
INDIVIDUALS REALLY SAID IT WAS
IMPORTANT TO ADDRESS DEPRESSION
AND TRAUMA AND STRESS AMONG
WOMEN WITH ALCOHOL USE, THERE
WAS A STRONG BELIEF ALCOHOL IS
USED TO COPE WITH STRESS MOOD
AND TRAUMA.
THEY SUGGESTED LINKING WOMEN
WITH ALCOHOL USE AND CO-MORBID
DEPRESSIVE SYMPTOMS OR TRAUMA TO
LOCAL ORGANIZATIONS THAT PROVIDE
COUNSELING SUPPORT AND OTHER
RESOURCES AS A WAY AUGMENTING
ALCOHOL INTERVENTIONS.
THE IMPORTANCE OF SENSITIVE TO
ALCOHOL RELATED STIGMA AND
CONSIDER THIS IN WHERE AND HOW
INTERVENTION WAS DELIVERED.
SO WE HAVE OUR SHARP WOMEN
COMMUNITY ADVISORY BOARD OR
COMMUNITY COLLABORATIVE.
IT INCLUDES RANGE OF
STAKEHOLDERS, IT DOESN'T INCLUDE
ALL BUT THE GREATER BALTIMORE
HIV HEALTH SERVICES PLANNING
COUNCIL, THE PRIOR DIRECTOR OF
THE BALTIMORE CITY HEALTH
DEPARTMENT STT HIV AND TB
CLINICAL SERVICES OLDER WOMEN
EMBRACING LIFE, HEALTHCARE FOR
THE HOMELESS, HOUSE OF RUTH, A
TRANSITIONAL HOUSING AND
INTERVENTION CENTER FOR DOMESTIC
VIOLENCE.
PREP CLINICS, SUBSTANCE USE,
PROGRAMS IN BALTIMORE AND MOST
IMPORTANTLY, MANY WOMEN
REPRESENTING ORGANIZATIONS MANY
WOMEN REPRESENT ORGANIZATIONS OF
LOCAL COMMUNITY AND WE HAVE FOUR
ADDITIONAL WOMEN FROM THE
COMMUNITY NOT AFFILIATED WITH
ONE OF THE ORGANIZATIONS.
SO WE WORKED TO DEVELOP A COMMON
MISSION TO ESTABLISH ACTIVE
INTERACTIVE COLLABORATIVE OF
WOMEN REPRESENTING ALL POINTS OF
CARE IN THE COMMUNITY TO IMPROVE
THE PHYSICAL MENTAL AND
SPIRITUAL HEALTH OF COMMUNITY
WOMEN BY MARSHALLING THE CAB
SKILLS TO INFORM ADVISE AND
PROVIDE ADVOCACY, CONNECTIONS TO
CARE AND CREATION OF
OPPORTUNITIES FOR CARE.
WE DEVELOPED CORE VALUES
INCLUDING RESPECT TRUST
CO-LEARNING DEVELOPMENT
PARTNERSHIP, SHARING OF IDEAS
AND OPENFUL RESPECTFUL AND
CARING FORMAT.
PRIVACY AND CONFIDENTIALITY AND
COMPASSION.
WE SIMILARLY DEVELOPED OUR SHARK
WOMEN MISSION WHICH IS TO
IMPROVE THE HEALTH WELL BEING
AND QUALITY OF LIFE OF WOMEN
WITH AND AT RISK OF HIV THROUGH
ACCESSIBLE RELEVANT STRENGTH
BASED COMMUNITY INFORMED WORK
THAT ADDRESSES UNHEALTHY ALCOHOL
USE ALONE AND INTERSECTION WITH
MENTAL HEALTH OTHER SUBSTANCE
USE AND REPRODUCTIVE HEALTH.
WITH A MISSION TO CREATE A SHARP
INTERVENTION SUSTAINABILITY
COMPREHENSIVE AND INSTILLS HOPE
WITH CORE VALUES OF SHARP
PROGRAM LISTED BELOW.
SO AFTER CAB FORMATION WE HAD A
NUMBER OF PARTNERSHIP
ACTIVITIES.
WHICH INCLUDED DEFINING
DESCRIBING THE COMMUNITY
CONTACT, IDENTIFYING HEALTH
PRIORITIES STRENGTH AND
RESOURCES AND BARRIERS TO CARE.
THIS INCLUDED IN DEPTH
INTERVIEWS WITH STAKEHOLDERS
ACROSS THE COMMUNITY FROM
MULTIPLE ORGANIZATIONS ALONG
WITH WOMEN LIVING WITH AND AT
RISK FOR HIV.
WE DISCUSSED RECRUITMENT AND
RETENTION STRATEGIES, WE WORK
TOGETHER ON INTERVIEW GUIDES,
RECRUITMENT MATERIALS, ON
ENHANCEMENT OF COMPUTER
DELIVERED INTERVENTION,
SELECTION OF COMMUNITY HEALTH
WORKER.
SO REALLY TRULY A PARTNERED
ACTIVITY.
I WANT TO PRESENT VERY BRIEFLY
SOME INITIAL RESULTS FROM OUR IN
DEPTH INTERVIEWS WE DID AND I
WILL GO THROUGH THEM QUICKLY.
SO WE WERE VERY INTERESTED IN
HIV PREVENTION AND ACTUALLY WAS
A MAJOR GOAL OF THIS U-34 THAT
CAME FROM OUR COMMUNITY.
THEY SAID YOU MUST ADDRESS PREP
AMONG WOMEN.
SO WE ASKED STARTED TO ASK WOMEN
IN THE COMMUNITY WHAT THEY HEARD
ABOUT HIV PRE-EXPOSURE
PROPHYLAXIS.
SO ONE WOMAN SAID I HEARD ABOUT
IT BUT I THOUGHT IT WAS FOR
PEOPLE WITH HIV AND ANOTHER SAID
HONESTLY I'M NOT SURE ABOUT
WOMEN BUT LOOKS LIKE EVERYTHING
I WAS SERING WAS GEARED TOWARD
MEN SO I FEEL LIKE THERE WAS
SOME WOMEN IN THE COMMERCIAL
THAT I THOUGHT THIS WAS REALLY
TARGETED TOWARDS GAY MEN, SO
THERE WAS THIS IDEA PREP FOR HIV
PREVENTION WASN'T FOR WOMEN.
ANOTHER WOMAN SAID YES YOU CAN
GET A PILL IF YOU HAVE HIV,
ANOTHER SAID IT WAS MENTIONED IN
ONE TREATMENT GROUPS, WE WERE
TALKING ABOUT HIV AND I WAS
SHOCKED THEY HAD IT.
SO REALLY HERE IS THIS
MEDICATION THAT ONE CAN TAKE TO
PREVENT HIV BUT THE WORD ISN'T
GETTING OUT THERE.
THAT WOMEN COULD USE IT.
SO IT WAS INTERESTING, ANOTHER
ONE SAID I HEARD ABOUT PREP AND
I HAVE A GRANDDAUGHTER TAKING
IT, IT'S EVERYWHERE.
YOU DON'T HEAR ABOUT IT AT
SCHOOLS.
WHEN WE ASK PROVIDERS ONE SAID
SO NOT MANY WOMEN, WHAT DO YOU
THINK WE CAN DO TO SORT OF GET
PROVIDERS THINK A LITTLE BIT
MORE ABOUT PREP?
THE PROVIDER SAYS I DON'T KNOW I
THINK THERE HAS TO BE
FUNDAMENTAL CHANGE IN MARKETING
BECAUSE ALL THE MARKETING DONE
THAT I SEE EVEN ONES THAT WE HAD
HANGING IN CLINIC ARE FOR MSM
AND CLEARLY THEY ARE HIGH RISK
THAT WOULD MAKE SENSE TO STARTS
THE ROLE OUT OF PREP THAT WAY
BUT I FEEL THERE NEEDS TO BE
SOME CHANGE IN THE MARKETING
FOOTPRINT.
SO WE ALSO LOOKED AT CLIENTS
DETERMINANTS OF ALCOHOL USE.
REALLY INTERESTED IN TRYING TO
GET A SENSE OF WHAT SPECIFICALLY
MIGHT BE TRIGGERS AS WE STARTED
TO THINK ABOUT HOW WE WERE GOING
TO TAILOR INTERVENTION.
AND COMMUNITY CAME UP IN TERMS
OF STRESS, I HAVE GROWN UP AND
LIVED IN THE COMMUNITY ALL OF MY
LIFE SO I KNOW IT EPS PRONE TO
VIOLENCE DRUGS, ALL TYPES OF
THINGS.
HOUSING CAME UP AS A CAUSE OF
STRESS.
I TOOK MY KIDS TO MY SISTER, I
DIDN'T WANT THEM TO SLEEP MT.
CAR.
ONCE I RAN OUT OF MONEY I LOST
MY JOB SO MY HOUSE, MY A MY JOB,
ALL MY MONEY WAS GONE AND IT WAS
GOING AND THEN THE SECOND CAR
GOT TOWED I HAD TO GIVE MY DOG
TO A FOSTER FAMILY BECAUSE I HAD
NOWHERE TO PUT HIM.
WORK STRESS, STRESS AND
AGGREGATION AND WHAT YOU GO
THROUGH IN YOUR JOB AND WITH
YOUR CHILDREN AND STUFF LIKE
THAT.
LEADS TO A LOT OF FRUSTRATION
AND STRESS.
WOMEN DISCUSS USING ALCOHOL TO
COPE.
AT THE TIME I WAS DRINKING IS
THE ONLY THING THAT HELP COPE
WITH WAKING UP AT EIGHT CLOCK
AND GO TO WORK THEN PARTY TO
RELIEVE STRESS OF HAVING TO GO
TO CLASS EVERY DAY I 8 IN THE
MORNING AND RFAING OVER WEST
BALTIMORE AND LIVED IN THE EAST.
THEY WANT TO HAVE FUN BUT WHY?
BECAUSE YOUR LIFE SUCKS, BECAUSE
YOU HAVE A DEAD END JOB, YOU
DIDN'T GO TO COLLEGE YOU HAVE
KIDS, YOU ARE A YOUNG AGE SO YOU
WANT TO GO OUT EVERY FRIDAY TO
DRINK AND COPE.
COPE WITH THE PAIN AND STRESS OF
YOUR LIFE.
BECAUSE YOU CAN'T COPE WITH IT
YOURSELF.
ANOTHER PERSON SAID I FEEL
BETTER, WHEN I TOOK A DRINK I
WASN'T THINKING ABOUT RAPE EVERY
DAY OR IT WAS NOT THE ONLY TIME
I THOUGHT ABOUT IT.
SEXUAL TRAUMA WAS SALIENT, CAME
UP IN ALL OUR INTERVIEWS.
UNSOLY AT THIS TIMED.
SO MUCH SO THAT WE REACHED
SATURATION, AFTER THREE OR FOUR
INTERVIEWS ON THIS THEME.
SO BALLPARK WHAT PERCENT OF
WOMEN HAD CHILDHOOD SEXUAL
EXPERIENCES.
TO BE HONEST PROBABLY 95% OF
THOSE WHO ARE -- USE SUBSTANCES.
RIGHT NOW A LOT OF WOMEN OUT
THERE THAT HAVE BEEN ABUSED, I
WOULD SAY 30% EXPERIENCE SEXUAL
ABUSE.
I WOULD SAY 89% AND THEIR MIND
IS GONE AND HERE THEY ARE IN
DRUG AND ALCOHOL TREATMENT.
75%.
DO WOMEN UNDERSTAND THE
CONNECTION BETWEEN SEXUAL ABUSE
AND LATER ALCOHOL AND DRUG USE?
I DON'T THINK SO BECAUSE ALL
THEY ARE TRYING TO DO IS GET RID
OF THE PAIN.
JUST NUMBING IT, THAT'S ALL I
WANT TO DO.
YES, IT DID, IT REALLY DID, MADE
ME DRINK MORE, MADE ME DRINK
MORE TO FORGET IT AND NOT TO
THINK ABOUT IT.
TO BLOCK IT OUT OF MY MEMORY.
THEN WE ASKED ABOUT ALCOHOL
TREATMENT.
AND THIS WAS ALSO REALLY
IMPORTANT BECAUSE WHAT YOU WILL
SEE, I PUT PROVIDER COMMENTS
NEXT TO CLIENT ONES IS NOT
EVERYONE KNOW WHERE IS TO GO.
ONE PERSON SAID I DON'T KNOW,
THEY DON'T ASK THE WORK GROUPS,
NOT THAT I KNOW OF IN BALTIMORE
CITY, HARD TO FIND BECAUSE IT IS
NOT PROMOTED IN SCHOOLS,
COLLEGES, NOT EVEN COMMUNITY
COLLEGES.
SOMEONE SAID AA.
SOMEONE SAID EVELYN JORDAN
CLINIC THAT'S CLOSED.
THERE'S NOT MANY PLACES.
SO WHEN DID YOU FINALLY FIND
GOOD TREATMENT?
WHEN FOR THE FIRST TIME SOMEBODY
WAS DEALING WITH MY ALCOHOL USE
AND MY MENTAL HEALTH.
SOMEBODY WAS DEALING WITH TWO
ENTITIES, NOT BEING ONE BUT
BEING TWO.
ME UNDERSTANDING I DON'T KNOW
WHEN THIS ONE IS WORKING OR THAT
ONE IS WORKING.
I AM GOING TO READ THIS NEXT
ONE.
BESIDES AA TO THEIR PRIMARY CARE
DOCTORS, DO PCPs TALK TO YOU
ABOUT ALCOHOL?
NO, THEY TALK ABOUT SEX AND THEY
TALK ABOUT DRUGS BUT NOT
ALCOHOL.
ONE MINUTE.
SO I WILL RUSH.
THE PROVIDER SAID I'M GOING TO
RUN THROUGH THIS QUICKLY.
MOST OF THE PROVIDERS SAID THEY
DIDN'T KNOW WHERE TO SEND
PATIENTS WITH ALCOHOL USE
DISORDER.
WHAT WERE THE SOLUTIONS?
THESE WERE GENERATED BY PATIENTS
ONES THAT PEOPLE TALKED ABOUT
MENTAL HEALTH TREATMENT AND I'M
GOING TO BRING UP USE OF PEERS.
WOMEN LIKE ME, THEY WANT TO DO
THAT, THEY HAVE A LITTLE
EXPERIENCE IN IT.
THEY NEED TO BE SOMEBODY THAT
DEALT WITH IT THEMSELVES.
A LOT OF FEEDBACK IMPORTANCE OF
USING PEERS IN THE INTERVENTION.
HERE IS A QUOTE, YOU CAN'T
ADDRESS THE DRUG TREATMENT OR
THE ALCOHOL USE OR THE COCAINE
ADDICTION YOU CAN'T ADDRESS THAT
WITHOUT GIVING THEM THE CUSHION
OF THE HOLISTIC APPROACH
ADDRESSING EVERYTHING ELSE
BECAUSE IF I HAD TO COME INTO A
PROGRAM, AND I WAS HOMELESS, IF
I HAD TO GO ON THE STREET EVERY
DAY I WOULDN'T HAVE STAYED
SOBER.
SO WHAT HAVE WE DONE?
WE HAVE CREATED BASED ON CLOSE
WORK WITH OUR COMMUNITY ADVISORY
BOARD, A HYBRID MODEL OF THE
COMPUTER AND COMMUNITY HEALTH
WORKER INTERVENTION, WHERE THE
COMPUTER IS USED AS AN
ENGAGEMENT TOOL, IT WORKS AT THE
INTERSECTION OF UNHEALTHY
ALCOHOL USE BUT DISCUSSES TRAUMA
AND OTHER MENTAL HEALTH ISSUES,
PEOPLE HAVE PERCEIVED THIS AS
LESS JUDGMENTAL AND WE USE
INFORMATION MOTIVATIONAL
BEHAVIORAL MODEL.
HEAVILY ADAPTED, WITH
INFORMATION FROM OUR CAB.
WE DEVELOPED A COMMUNITY HEALTH
WORKER MANUAL, IN PARTNERSHIP
WITH COMMUNITY MEMBERS.
AND WE ARE CURRENTLY PILOTING
THIS IN THE HIV CLINIC AND SOON
STI CLINICS IN BALTIMORE CITY
WITH THE GOAL OF REALLY GETTING
WOMEN TO THE RESOURCES THAT THEY
NEED.
I WILL END HERE SO AS TO NOT GO
MORE THAN ONE MINUTE OVER.
THANK YOU.
I WOULD LIKE TO ACKNOWLEDGE OUR
CAB OUR PARTICIPANTS, SCIENTIFIC
COLLABORATOR AND NIAAA.
>> THANK YOU SO MUCH DR. CHAMBER
FOR THAT PRESENTATION.
NOW WE WILL MOVE OVER TO DR.
MCKEE.
TODAY I WILL TALK COLLABORATIVE
CARE MODEL THAT WE DEVELOPED TO
SUPPORT THE SPECIAL REENTRY FROM
INCARCERATION.
A COUPLE OF SLIDES ABOUT CURRENT
TRENDS IN THE CRIMINAL JUSTICE
SYSTEM, AND THEN I WILL SPEND
MAJORITY OF THE TIME TALKING
ABOUT THE DEVELOPMENT OF
INTEGRATED SYSTEM OF CARE FOR
SIT SEN RETRY AND INITIAL
OUTCOMES HIGHLIGHTING
(INAUDIBLE).
THE UNITED STATES HAS THE
HIGHEST INCARCERATION RATES IN
THE WORLD CURRENTLY AND ACCOUNTS
FOR MORE THAN ONE FIFTH OF THE
WORLD PRISONERS, WITH
APPROXIMATELY 2.2 MILLION PEOPLE
IN CUSTODY ON A GIVEN DAY.
THIS IS ALSO TRUE FOR WOMEN.
THAT INTERESTING TO NOTE THAT
THE U.S. COMPRISES ABOUT 4% OF
THE WORLD FEMALE POPULATION BUT
ACCOUNTS FOR OVER 30% OF THE
WORLD INCARCERATED WOMEN.
ALONG WITH INCARCERATION COMES
HYBRID RECIDIVISM FOR RETURN TO
INCARCERATION.
THIS DATA HERE FROM CONNECTICUT
LOOKS VERY SIMILAR ACROSS THE
US. WE SEE THAT THERE'S RATES
OF 64% OF NEW ARRESTS AND 54% OF
RETURN TO PRISON WITHIN A THREE
YEAR TIME STAMP.
AND WHEN YOU LOOK AT THE REASONS
FOR RECIDIVISM, AGAIN THE DATA
FROM CONNECTICUT IS SHOWING THAT
DRUG RELATED CRIMES SO THIS IS
NON-VIOLENT DRUG RELATED CRIME
THAT ACCOUNTED FOR 45% OF
RECIDIVISM.
AND THIS IS AN ISSUE THAT I HAVE
BEEN FOCUSED ON THAT WE ARE
CRIMINALIZING NON-VIOLENT
ADDICTION RELATED BEHAVIOR
RATHER THAN TREATING ADDICTION.
WE APPLIED FOR FUNDING FROM SAM
A IS A, THE MENTAL HEALTH
SUBSTANCE USE SERVICE
ADMINISTRATION WHICH FUNDS
SERVICE DELIVERY GRANTS AND
RESPONDED TO RFA TO EXPAND OR
ENHANCE SUBSTANCE USE TREATMENT
AND RELATED RECOVERY AND REENTRY
SERVICES.
SO WITH THIS FUNDING, WE
DEVELOPED THE LIVING FREE
PROGRAM WHICH IS A COLLABORATIVE
CARE MODEL AND PAIRS ADDICTION
AND MENTAL HEALTHCARE WITH
PRIMARY HEALTHCARE AND PEER
MENTORSHIP SUPPORT.
THIS REPRESENT HEARSAY A
PARTNERSHIP BETWEEN US AT YALE
AND STATE PARTNERS DEPARTMENT OF
CORRECTIONS AND MENTAL HEALTH
AND ADDICTION SERVICES.
FROM THE VERY OUTSET WE WANTED
TO KNOW FROM OUR PARTNERS WHAT
WOULD SUPPORT SUSTAINABILITY OF
SUCH A PROGRAM.
THEY ARE PRIMARY TWO RESPONSES
TO THE QUESTION WAS, IS THE
PROGRAM COST EFFECTIVE, AND DOES
THE PROGRAM REDUCE RECIDIVISM.
SO THE TARGET POPULATION WE ARE
RECRUITING TO THE PROGRAM, THEY
HAVE TO BE PRESENTED WITH
SUBSTANCE USE DISORDER IN NEED
OF TREATMENT AND THIS ACCOUNTS
FOR 80% OF THOSE CURRENTLY
INCARCERATED.
SO FAR WE HAVE RECRUITED 650
WOMEN AND MEN INTO OUR PROGRAM.
THEY MAY HAVE CHRONIC HEALTH
CONDITIONS IN THE CONNECTICUT
PRISON SYSTEM CHRONIC HEALTH
CONDITION, EXISTS AMONG 40% OF
THOSE INCARCERATED.
MUST BE INCARCERATED FOR THREE
MONTHS PER RFA, THE GRANT.
AND IT CAN BE ANY DISCHARGE
STATUS, SO CAN BE ACTUALLY END
OF SENTENCE OR ON SOME LEVEL OF
COMMUNITY SUPERVISION SUCH AS
PROBATION OR PAROLE.
WHEN WE DID A NEEDS ASSESSMENT
FOR THIS PROGRAM WE DISCOVERED
THAT A THOUSAND INDIVIDUALS WERE
BEING RELEASED PER YEAR BACK TO
THE GREATER NEWHAVEN AREA THAT
MET ELIGIBILITY CRITERIA.
SO WE STARTED PROVIDING SERVICES
WHILE THE PERSON IS STILL
INCARCERATED.
AND WE WORK WITH OUR DOC
PARTNERS WITH REGARD TO
RECRUITMENT, SO THEY ARE ABLE TO
IDENTIFY INDIVIDUALS WHO ARE
ABOUT TO LEAVE INCARCERATION SO
WITHIN SIX MONTHS RELEASE THAT
MEET ELIGIBILITY CRITERIA.
WE THEN HAVE THEM MEET WITH
ADDITION COUNSELOR AND HAVE THEM
CONSENT TO TREATMENT WE THEN DO
ANOTHER MEETING WITH THEM IN THE
FACILITY WITHIN TWO MONTHS OF
RELEASE AT THIS POINT THEY MEET
WITH THEIR ADDICTION COUNSELOR
AND PEER MENTOR.
THERE IS A MOTIVATIONAL
ENHANCEMENT APPROACH TO INCREASE
MOTOR DIVISION TO ENGAGE
COMMUNITY TREATMENT ONCE
RELEASED.
AND ALSO AT THIS MEETING START
TO DEVELOP INDIVIDUALIZED
TREATMENT PLAN FOR INTEGRATED
CARE.
WE THEN ALSO PROVIDED AN
ESCORTED VISIT TO OUR CLINIC.
CLINICAL DIRECTOR OF THE CLINIC
HERE IN THE PICTURE LOCATE
MISDEMEANOR THE LOVELY AREA OF
CONNECTICUT.
WE DID A VISIT ONE MONTH PRIOR
TO RELEASE AND THE GOALS OF THIS
MEETING ARE FOR THEM TO SEE THE
PHYSICAL LOCATION OF THE CLINIC,
CONTINUE TO BUILD THERAPEUTIC
RELATIONSHIP AND MEET WITH THE
ENTIRE TEAM INCLUDING ADDICTION
PSYCHIATRIST SO WE CAN START TO
EVALUATE NEEDS FOR MATCH FOR
PSYCHIATRIC MEDICATION, UPON
RELEASE.
CURRENTLY DOC DOES HAVE LIMITED
PROVISION PROVIDING THAT DURING
INCARCERATION BUT THIS IS BY NO
MEANS STATEWIDE AT THIS POINT.
SO UNDERSTANDING MEDICATION
NEEDS UPON RELEASE IS REALLY
CRITICAL.
ONE THE PERSON IS RELEASED FROM
INCARCERATION, THEY ENGAGE IN
ADISTRIBUTION TREATMENT AT THE
FOURTH CLINIC.
THIS IS VICKIE HERE AT THE FRONT
DOOR, WE HAVE A TEAM APPROACH
THE AID CARE, ALL CLINICIANS ARE
TRAINED IN EVIDENCE BASED CARE,
ALL MY CLINICIANS ARE EITHER
Ph.D. OR MA LEVEL CLINICIAN.
AND AGAIN TO SAY HA OUR CLINIC
IS A STATE FUNDED CLINIC, IT IS
A SATELLITE CLINIC OF THE LOCAL
STATE FUNDED HOSPITAL LOCATED IN
NEWHAVEN.
ALL TREATMENT IS PERSON CENTERED
AND INDIVIDUAL SO EACH PERSON'S
PRIMARY MODALITY AS INDIVIDUAL
THERAPY GROUPS ADJUNCTIVE WE
HAVE HARM REDUCTION APPROACH, WE
PRACTICE TRAUMA VIOLENCE AND
GENDER INFORMED CARE, MEDICATION
ASSISTED TREATMENT, IS KEY, WE
HAVE A WELL DEVELOPED OPIOID
OVERDOSE PREVENTION PLAN.
THE LENGTH OF TREATMENT IS
MINIMUM THREE MONTHS BUT THERE
IS NO MAXIMUM SO WE DO HAVE
CLIENTS WHO STAY FOR SOME
MONTHS, SOME YEARS IN CERTAIN
CASES.
WE HAVE EMPLOYMENT SPECIALIST AS
PART OF THE TEAM AND CAN SUPPORT
SOBER HOUSING WITH GRANT FUNDS.
SO IN ADDITION TO ALL THE
QUANTITATIVE DATA WE COLLECT WE
ALSO COLLECT QUITE A BIT
QUALITATIVE DATA.
SO I WILL PRESENT QUOTES FROM
OUR CLIENT.
WITH REGARD TO ADDICTION CARE
NOW AND CLEAN, I'M NOT GETTING
MAD GETTING CRAZY, THINKING
STUPID THINGS, YOU KNOW WHAT I
MEAN, I'M CLEAR HEADED.
I'M THINKING NOW.
I DID LEARN SOME COPING SKILLS,
HOW TO TAKE MYSELF OUT OF THAT
HE MOMENT AND PUT MYSELF IN THE
PRESENT BECAUSE I HAVE PANIC
ATTACKS AND I'M LEARNING WAYS TO
COPE WITH THEM AND ONLY THROUGH
THIS PROGRAM THAT I HAVE LEARNED
THOSE WAYS.
JAWANNA IS A CLINICIAN THAT
SPECIALIZES IN TRAUMA INFORMED
CARE.
I USED TO GET NUMB MYSELF AND I
DON'T THINK ABOUT THE TRAUMA SO
THAT IS A VERY BIG PART.
THAT IS WHAT THE ONE ON ONE
COUNSELING WAS, GREAT FOR ME
LIKE WITH TRAUMA BECAUSE THERE
WERE THINGS I WOULDN'T WANT TO
TALK ABOUT IN A GROUP SETTING,
IT WAS NICE TO HAVE ONE ON ONE
COUNSELING WHERE YOU CAN TALK
ABOUT THINGS LIKE THAT AND THERE
WERE ALWAYS DIFFERENT
UNDERSTANDING IN EVENTS, THEY
WERE ALWAYS REALLY COOL.
SO WITH REGARD TO OUR OPIOID
OVERDOSE PREVENTION PLAN ALL THE
STARTS WITH STAFF TRAINING, WE
HAVE NALOXONE ON SITE AT CLINIC
WE CAN PROVIDE CLIENTS, WE START
TO IDENTIFY RISK OF OVERDOSE,
PRE-RELEASE WITH THE FIRST
APPOINTMENT TO UNDERSTAND WHERE
THEY ARE PERSONS PRESENTING WITH
OPIOID DEPENDENCE ISSUE.
WE EVALUATE MEDICATION
PRE-RELEASE VERY STRONGLY
ADVOCATE FOR THE PERSON TO TAKE
A MATCH, POST RELEASE WE ENGAGE
CLIENTS, MEDICATION AS SOON AS
POSSIBLE, HAVE VERY CLOSE
MONITORING, PROVIDE THEM WITH
NALOXONE AND ALSO TO OFFER TO
TRAIN FRIENDS AND FAMILY TO
ADMINISTER NALOXONE.
WE HAVE INTEGRATIVE PRIMARY
HEALTHCARE PROVIDED BY THE
TRANSITION CLINIC LED BY EMILY
WANG.
THE CLINIC EMPLOYS COMMUNITY
HEALTH WORKERS TO HELP CLIENTS
NAVIGATE HEALTHCARE SYSTEMS.
AND IMPORTANT TO NOTE THAT
ACCESS TO PRIMARY CARE IS RAPID
UPON RELEASE.
WE ALSO PROVIDE PEER SUPPORT
MENTORSHIP, THIS PORTION OF THE
PROGRAM IS LED BY SHEER REEL
BELAMINE AN EXPERT IN PEER
MENTORS SO WE HAVE STAFF WITH
LIVED EXPERIENCE WITH ADDICTION
AND INCARCERATION TO HELP OUR
CLIENTS NAVIGATE REENTRY SO THEY
PROVIDE CASE MANAGEMENT, CONTACT
IS FREQUENT STARTING WHEN THE
PERSON IS STILL INCARCERATED,
THEN CAN BE DAILY MULTIPLE DAILY
CONTACT UPON RELEASE.
THE PEER MENTORS ALSO LEAD A
WEEKLY GROUP, THAT IS WHY I DID
ALL THESE GROUPS, THEY HELP ME
AT THE BEGINNING, I DIDN'T THINK
IT WOULD, I'M 60 YEARS OLD I
SAID WHAT THE HELL ARE THEY
GOING TO TELL ME.
SO WITH REGARDS TO SYSTEM OF OUR
DATA I'M GOING TO PRESENT SOME
DATA ON OUR FIRST 260
PARTICIPANTS.
WE CAN SEE THAT JUST OVER A
THIRD OF OUR PARTICIPANTS WERE
WOMEN.
ABOUT 63% MEN.
FAIRLY WELL MATCHED IN TERMS OF
AGE.
INTERESTING DIFFERENCE IN RACIAL
COMPOSITION, 64% WHITE.
WE SEE THAT IS ABOUT 60% BLACK
FOR MEN.
WE DID THIS ANALYSIS VERY EARLY
ON LOOKING AT INCARCERATION
HISTORY AMONG OUR SAMPLES
BECAUSE WE WANTED TO UNDERSTAND
WHO WE WERE RECRUITING INTO THE
PROGRAM.
AND WE FOUND OUT THAT ABOUT 20%,
MAJORITY OF 90% INCARCERATED
MULTIPLE TIMES, ABOUT 20%
INCARCERATED MORE THAN 15 TIMES
IN THEIR LIFETIME, IN AND OUT OF
INCARCERATION.
WHEN WE LOOK AT THE REASONS FOR
THIS INCARCERATION THE TOP SIX
MOST PREVALENT REASONS WERE FOR
NON-VIOLENT CRIMES, VIOLATION OF
PROBATION, BREACH OF PEACE,
FAILURE TO APPEAR, LARCENY,
VARIOUS DRUG RELATED CRIMES, ET
CETERA.
WHEN WE LOOK AT PRIMARY
SUBSTANCE ABUSE CLINICIAN RATED,
WE SEE SOME INTERESTING GENDER
DIFFERENCES THAT WOMEN WERE MORE
LIKELY TO HAVE AN OPIOID USE
DISORDER, AND COCAINE USE
DISORDER.
WHEREAS MEN MORE LIKELY TO HAVE
AN ALCOHOL USE DISORDER OR
CANNABIS USE.
WE SEE NO DIFFERENCE IN RATES OF
POLYSUB STANCE USE BUT WOMEN ARE
USING MORE RISKY PATTERNS OR
COMBINATIONS OF MORE LIKELY
COMBINED HEROIN COCAINE, MEN
MORE LIKELY TO COMBINE ALCOHOL
AND CANNABIS.
PSYCHIATRIC MORBIDITY, WE SEE
THAT WOMEN WERE MORE LIKELY TO
HAVE PSYCHIATRIC DIAGNOSES THAN
MEN, AND WHEN WE LOOK AT OUR
MOST COMMON DIAGNOSES WE CAN SEE
GREATER RATES IN WOMEN ACROSS
THE BOARD.
INTERESTING WE SEE ONCE YOU HAVE
A PSYCHIATRIC DISORDER YOU ARE
PRETTY EQUALLY LIKELY TO HAVE
ANOTHER PSYCHIATRIC DISORDER IN
WOMEN THAN MEN.
WOMEN MORE LIKELY TO HAVE
GREATER SUICIDE RISK THAN MEN.
WOMEN WERE ALSO MORE LIKELY TO
HAVE GREATER RATES OF VIOLENCE
AND TRAUMA.
WE ALSO NOTED WOMEN WERE MORE
LIKELY TO ENDORSE SYMPTOMS
RELATED TO THE TRAUMA, SUCH AS
NIGHTMARES, AVOIDANCE, BEING ON
-- NUMB OR DETACHED.
WOMEN WERE ALSO MORE LIKELY TO
HAVE GREATER RATES OF CHRONIC
HEALTH CONDITIONS, I LISTED THE
MOST COMMON HEALTH CONDITIONS
HERE WE DIDN'T SEE ANY
DIFFERENCE BETWEEN MEN AND WOMEN
ON THE HEALTH CONDITIONS
REPORTING.
WITH REGARDS TO TREATMENT
OUTCOME, WE SEE NO DIFFERENCES
IN THE RATE OF ENGAGEMENT
BETWEEN MEN AND WOMEN.
WE SEE THAT ALTHOUGH WOMEN HAD
HIGHER RATES OF HEALTH
CONDITIONS THEY WERE LESS LIKELY
TO ENGAGE IN PHYSICAL
HEALTHCARE.
NONETHELESS WE WERE ABLE TO
VERIFY AND HELP SUPPORT RECENT
HIV AND HEP C TESTING TO OUR
CLIENTS.
WOMEN AND MEN HAD SIMILAR
NUMBERS OF CHILDREN BUT WOMEN
WERE MORE LIKELY TO HAVE
CHILDREN CUSTODIAL CARE SO THIS
WOULD BECOME A MAJOR FOCUS OF
THEIR TREATMENT MEN AND WOMEN
WERE EQUALLY LIKELY TO ENGAGE IN
MATH AND EQUALLY LIKELY TO
ACCESS NARCAN KIT.
WE HAD A METHADONE PARTNER RIGHT
IN THE BUILDING WITH US AND WE
PROVIDED NALOXONE.
RATES OF HOUSING AND EMPLOYMENT
WERE HIGH AND NO DIFFERENCE
BETWEEN MEN AND WOMEN.
WHEN WE LOOK AT WHO COMPLETED
THREE MONTHS OF TREATMENT WE
HAVE SIMILAR RATES BETWEEN MEN
AND WOMEN, AFTER THE MINIMUM
TREATMENT PERIOD WE ARE AT A
POINT WHERE CLINICIAN EVALUATES
PERSON STABLE ENOUGH TO BE
DISCHARGED FROM TREATMENT.
WE HAD OVER 20% MEN AND WOMEN
ELECT TO STAY LONGER FOR LONGER
TERM TREATMENT, SUPPORTED IN
ADDICTION CARE AND WE ALSO HAD
EQUALLY HIGH RATES OF ABSTINENCE
FOR MEN AND WOMEN AT THE POINT
OF TREATMENT COMPLETION.
IN TERMS OF LONGER TERM
OUTCOMES, LOOKING AT SIX MONTHS
FOLLOWING DISCHARGE WE SEE THAT
WOMEN CONTINUE TO HAVE HIGHER
RATES OF DEPRESSION AND ANXIETY
BUT IMPORTANTLY THERE WERE ALSO
MORE LIKELY TO CONTINUE TAKING A
PSYCHIATRIC MEDICATION TO TREAT
THOSE SYMPTOMS.
RATES OF NEW TRAUMA AND
VICTIMIZATION WERE LOW BUT STILL
TOO HIGH AT 5% FOR WOMEN.
WHEN WE LOOK AT RATES OF
ABSTINENCE AT SIX MONTHS POINT
YOU SEE HIGH RATES FOR ALCOHOL,
SOMEWHAT LOWER FOR DRUGS.
AND AGAIN NO DIFFERENCE BETWEEN
MEN AND WOMEN.
WHEN WE LOOK AT RECIDIVISM, WHAT
WE DO HERE IS A VERY PRELIMINARY
LOOK BUT THE GREEN BAR IS THE
STATE AVERAGE OF RETURN TO
PRISON WITHIN 36 MONTH WINDOW,
WE SEE NO DIFFERENCE BETWEEN MEN
AND WOMEN.
WE SEE CRIMES WHICH THEY RETURN
TO PRISON WERE EVENLY SPLIT
BETWEEN FELONY AND MISDEMEANORS
AND VIOLENT AND NON-VIOLENT
CRIME.
BUT CERTAINLY GOING TO BE DOING
A MUCH CLOSER LOOK AT THIS
OUTCOME AND GOING TO BE FORMING
A CONTROL GROUP WITH
ADMINISTRATIVE DATA AND USING
PROPENSITY MATCHING.
SO IN SUMMARY WOMEN HAVE HIGHER
RISK OF SUBSTANCE USE AND
RISKIER COMBINATIONS OF
SUBSTANCES.
THERE'S GREATER PSYCHIATRIC
CO-MORBIDITIES SUICIDE RISK,
VIOLENCE TRAUMA AND CHRONIC
HEALTHCARE CONDITIONS AMONG THE
WOMEN WE ARE TREATING.
LESS LIKELY TO ENGAGE IN PRIMARY
HEALTHCARE, MORE LIKELY TO HAVE
ONGOING PSYCHIATRIC SYMPTOMS,
THOUGHTS ON THE OTHER SIZE OF
THIS, THEY ENGAGED IN TREATMENT
AT SAME RATES AS MEN, HOUSED
EMPLOYEES SIMILAR RATES OF
TREATMENT COMPLETION ABSTINENCE
AND RECIDIVISM, ENGAGE IN
ONGOING TREATMENT TO MANAGE
THEIR PSYCHIATRIC SYMPTOMS.
SO WITH THAT I WILL CONCLUDE AND
THANK ALL THE WONDERFUL
CLINICIANS, CLINICAL PARTNERS
AND STATE PARTNERS INVOLVED IN
PROGRAMS.
THANK YOU.
>> THANK YOU, DR. MCKEE FOR THAT
WONDERFUL PRESENTATION ON MODELS
OF CONTINUUM OF CARE TO IMPROVE
OUTCOMES OF WOMEN RETURNING TO
THE COMMUNITY FROM
INCARCERATION.
NOW WE WILL TURN IT OVER TO DR.
FAYE TAXMAN.
THANK YOU VERY MUCH AND I TOO
WANT TO THANK EVERYONE FOR THE
INVITATION TO PARTICIPATE IN
THIS PARTICULAR SEMINAR AS WELL
AS TO HAVE AN OPPORTUNITY TO
TALK ABOUT SYSTEMS OF CARE
MODELS REGARDING THE LEGAL
SYSTEM AND OTHER CARE SYSTEMS.
SO MY PRESENTATION TODAY WILL
DRAW UPON THE HISTORY OF
DIFFERENT WAYS IN WHICH WE
APPROACH SYSTEMS OF CARE IN THE
LEGAL SYSTEM AND I DO THIS FOR
PARTICULAR PURPOSE OF TRYING TO
REALLY GET US AT A PLACE OF
THINKING ABOUT SOME OF THE MORE
COLLABORATIVE MODELS BUT ALSO
SOME OF THE DECISION SUPPORT
MODELS THAT WE HEARD ABOUT
YESTERDAY FROM DR. OSMER AS WELL
AS FROM MY COLLEAGUES TODAY.
I WANT TO BEGIN -- OOPS SORRY.
I WANT TO BEGIN BY ACKNOWLEDGING
THAT THIS PRESENTATION DRAWS
UPON A NUMBER OF DIFFERENT
STUDIES, BUT I AM PRIMARILY
GOING TO BE TALKING ABOUT THE
MA'AMPET STUDY I DID WITH DR.
SCOTT WALTER WHOSE IS AT THE
UNIVERSITY OF NORTH TEXAS AND IT
WAS A COMPUTERIZED MOTIVATIONAL
INTERVIEWING ASSESSMENT TOOL
COMBINED WITH SOME DECISION
SUPPORT GUIDANCE.
I'M ALSO GOING TO BE DRAWING
UPON A PROJECT THAT IS LED BY
DR. KATE ELKIMGTON AND GAIL
WASSMAN OUT OF COLUMBIA
UNIVERSITY, CALLED PROJECT
ECONNECT WHICH IS DESIGNED TO
PUSH DECISION SUPPORT, MODELS TO
BE ABLE TO DO ACTUALLY DIRECT
PLACEMENT INTO CARE AND THEN I'M
GOING TO ALSO HIGHLIGHT SOME OF
THE SPECIFIC MODELS THAT WE HAVE
DEVELOPED ON DECISION SUPPORT
DEALING WITH THE CRIMINAL LEGAL
SYSTEM.
SO DR. MCKEE ALREADY PRESENTED
SOME OF THIS INFORMATION BUT I
THINK IT IS REALLY RELEVANT FOR
US TO LOOK AT THE BIG PICTURE.
SO WHAT IS THE LIFE LIKELIHOOD
OF A WOMAN BEING INVOLVED IN THE
JUSTICE SYSTEM?
ESSENTIALLY WE -- THE FINDINGS
ARE THAT ONE IN 56 WOMEN IN OUR
SOCIETY IN THE U.S. SOCIETY WILL
BE INVOLVED IN THE LEGAL SYSTEM
BUT THAT THERE ARE VARIATIONS IN
THAT INVOLVEMENT AND OF COURSE
MINORITIES BLACK AND BROWN WOMEN
HAVE GREATER LIKELIHOODS OF
BEING INVOLVED IN THE LEGAL
SYSTEM.
DR. MCKEE SPOKE TO US ABOUT THIS
ISSUE ABOUT THE HIGH RATE OF
INCARCERATION AND HOW THAT
ACTUALLY IS TRUE FOR WOMEN AS
WELL AS FOR -- IN THE SYSTEM.
BUT WHAT I WANT TO BRING
ATTENTION TO IS THE FACT THAT
ALTHOUGH WE HAVE 1.9 MILLION
PEOPLE INCARCERATED WHAT THAT
ACTUALLY IS AROUND 200,000 OR
ACTUALLY WOMEN BUT ACTUALLY OUR
LARGER SYSTEMS ARE PEOPLE ON
PROBATION AND PAROLE WHERE WE
HAVE ALMOST 5 MILLION ADULTS ON
PROBATION PAROLE IN THE UNITED
STATES AND WHAT WE ACTUALLY FIND
IS 25% OF THOSE WOMEN, 25% PRO
BIG POPULATION ARE WOMEN, AND
MORE IMPORTANTLY THIS IS A
FEEDER FOR INCARCERATION BECAUSE
FAILURE IN THE COMMUNITY
ACTUALLY FEED THE INCARCERATION
RATES BOTH IN OUR LOCAL JAILS AS
WELL AS IN STATE PRISONS.
WE ALSO KNOW GIRLS IN THE
JUVENILE JUSTICE SYSTEM ARE
HIGHLY PREVALENT AT 30% ARREST,
ACTUALLY HAVE TO DO WITH GIRLS
AND 15% OF THE INCARCERATED
YOUTH ARE GIRLS SO THE PREVALENT
-- THE IMPORTANCE OF THIS TOPIC
IS THAT WE HAVE A LOT OF WOMEN
AND GIRLS IN THE LEGAL SYSTEM.
AT HIGHER RATES AND OF COURSE
MINORITIES LOW INCOME THAT WE
HAVE ALREADY DISCUSSED.
I DO WANT TO RAISE THE ISSUE
ABOUT THE HEALTH ISSUES.
THE THING WE KNOW ABOUT THE
LEGAL SYSTEM IS A RESULT OF THE
WAR ON DRUGS, AND OUR SOCIAL
WELL PAIR POLICIES, OR LACK OF
SOCIAL WELFARE POLICIES, WE HAVE
A HIGHER CONCENTRATION OF PEOPLE
INVOLVED IN THE LEGAL SYSTEM
THAT HAVE SUBSTANCE USE
DISORDERS, MENTAL HEALTH
DISORDERS, AND INFECTIOUS
DISEASES.
AND WOMEN WERE IN THE LEGAL
SYSTEM ACTUALLY HAVE HIGHER
RATES THAN NORM FOR THE SYSTEM
OVERALL.
WHEREAS ABOUT 50% OF PEOPLE
LEGALLY INVOLVED HAVE SOME SORT
OF SUBSTANCE USE DISORDER, WE
FIND THAT WOMEN ARE CLOSER TO 70
TO 80% SUBSTANCE USE DISORDERS
AND MORE WOMEN HAVE CO-OCCURRING
DISORDERS AS WELL AS CO-MORBID
HEALTH CONDITIONS.
SO GREAT NEED IS TO THINK ABOUT
HOW WE CONNECT PEOPLE IN THE
LEGAL SYSTEM WITH SERVICES IN
THE COMMUNITY OR PROVIDE
SERVICES WITHIN THE LEGAL SYSTEM
IF SOMEONE IS IN AN
INCARCERATION SETTING.
THERE ARE DIFFERENT POINTS WHICH
WE ACTUALLY LOOKED AT AND TESTED
OUT SYSTEMS OF CARE OVER THE
LAST ABOUT 35, 40 YEARS.
THESE SYSTEMS IMPACT WOMEN AND
GIRLS WHO ARE ON THE STREET, WHO
HAVE BEEN ARRESTED, WHO ARE IN
JAIL WHO ARE IN PRISON, ON
PROBATION AND PAROLE.
THEY ALSO INVOLVE DIFFERENT
SERVICE SYSTEMS, MENTAL HEALTH,
SUBSTANCE ABUSE, MEDICAL CARE,
EMPLOYMENT SYSTEMS AND THE
MODELS THAT WE HAVE BEEN RELYING
UPON ARE MODELS THAT REALLY
BASICALLY FOCUS IN ON
IDENTIFYING WOMEN OR GIRLS OF
NEED, AND NEED HERE DEPENDS UPON
WHETHER WE ARE TALKING MENTAL
HEALTH OR SUBSTANCE ABUSE
SERVICES.
THAT IDENTIFICATION PROCESS
USUALLY OCCURS WITH SCREENING
AND ASSESSMENT IN THE LEGAL
SYSTEM, THE REFERRAL PROCESS
ALSO OCCURS IN THE LEGAL SYSTEM
BUT THEN OFTEN TIMES THE EFFORT
FROM THE REFERRAL IS TO ACTUALLY
INITIATE SERVICES IN ANOTHER
SYSTEM LIKE A COMMUNITY MENTAL
HEALTH SYSTEM OR A SUBSTANCE
ABUSE TREATMENT SYSTEM.
WHAT WE ACTUALLY FIND, THIS IS
WHERE THE CASCADE OF CARE MODELS
THAT HAVE BECOME MORE PREVALENT
AND USED IN OUR STUDIES HAVE
BASICALLY SHOWN US THAT WHILE AS
WE HAVE SCREENING ASSESSMENT
TOOLS THAT CAN BE PUT IN PLACE
IT IS AT THE REFERRAL AND
INITIATION STAGE IN WHICH THIS
TRANSITION OF CARE DOES NOT
OCCUR.
AND THAT ESSENTIALLY WE DON'T
GET THE BENEFITS THAT WE WOULD
SEE FROM THE RECIDIVISM
REDUCTION PROGRAMS OR PROGRAMS
TO DEAL WITH SUBSTANCE USE AND
MENTAL HEALTH DISORDERS IN THE
SAME WAY BECAUSE OF THE FACT
THAT NOT ENOUGH WOMEN AND GIRLS
ARE ACTUALLY INITIATING
TREATMENT SERVICES.
SO THAT BECOMES THE MAJOR
BOTTLENECK, HOW TO DEVELOP
SYSTEMS OF CARE WHICH WE LINK
THE LEGAL SYSTEM WITH THE
DIFFERENT VARIETIES OF SOCIAL
SERVICES OR MEDICAL SERVICES IN
THE COMMUNITY.
SO JUST TO GO OVER SOME OF OUR
CHALLENGES, OUR CHALLENGES HAVE
TO DO WITH THE STATE OF
PRACTICE.
WHEN I SAY THAT I AM TALKING
ABOUT FACT THAT ESSENTIALLY MOST
OF OUR PRACTICE IS AROUND
DIFFERENT VARIETIES OF CASE
MANAGEMENT SYSTEMS, IN WHICH WE
HAVE SOME SORT OF LINKAGE OR
SOME SORT OF ASSESSMENT PROCESS,
USING A STANDARDIZE SCREENING
ASSESSMENT TOOL AND THEN THERE
IS A CASE PLAN DEVELOPED AND
TENDENCY IS FOR THOSE CASE PLANS
TO ACTUALLY BE DELIVERED BY THE
PERSON IN NEED.
IN THIS CASE WOMEN IN THE LEGAL
SYSTEM.
ESSENTIALLY WE ALSO KNOW THAT WE
HAVE A DERTH OF SERVICES IN THE
COMMUNITY SO EVEN IF A WOMAN OR
GIRL WAS HIGHLY MOTIVATED, THE
OPPORTUNITIES TO BECOME INVOLVED
IN SERVICES ARE COMPLEX.
THEY ARE EVEN MORE COMPLEX
BECAUSE OF THE CASE MANAGEMENT
MODELS THAT WE HAVE RELIED UPON.
IN A RECENT TRIAL CONDUCTED BY
THE -- ABOUT SIX RESEARCH
CENTERS AS PART OF THE JJ TRIALS
THAT INVOLVED 33 COMMUNITIES
ACROSS THE UNITED STATES, WE
LOOKED AT SOME BASELINE
INFORMATION ABOUT HOW IS THE
SYSTEM REALLY WORKING.
IN THIS CASE TALKING ABOUT THE
SYSTEMS, I'M TALKING ABOUT A
SYSTEM WHERE THE LEGAL SYSTEM IS
RESPONSIBLE FOR SCREENING GIRLS
AND BOYS IN THIS CASE BECAUSE WE
ARE TALKING ABOUT THE JUVENILE
JUSTICE SYSTEM, WHERE SUBSTANCE
USE AND/OR MENTAL HEALTH
PROBLEMS AND THE LEGAL SYSTEM IS
RESPONSIBLE FOR SORT OF THOSE
REFERRALS THAT WOULD ACTUALLY BE
-- WOULD HELP PEOPLE INITIATE
CARE.
SO WE FOUND IN THIS PARTICULAR
TRIAL THESE PROBATION AND PAROLE
SITES, THAT ABOUT 70% OF THE
YOUTH THAT WERE SCREENED FOR
SUBSTANCE USE PROBLEMS ABOUT
HALF OF THOSE NEEDED TREATMENT.
AND INDICATORS OF FACTORS WITHIN
THE JUSTICE SYSTEM THAT WERE
CONTRIBUTING TO THIS NEED FOR
TREATMENT WHETHER OR NOT THE
YOUTH HAD ALCOHOL OR DRUG
CHARGE.
IF THE YOUTH HAD AN ALCOHOL OR
DRUG CHARGE, THE PROBATION
PAROLE OFFICER WAS MUCH MORE
LIKELY TO INCREASE THE REFERRAL
RATES.
HOWEVER, WE FOUND OF THOSE YOUTH
THAT NEEDED TREATMENT REFERRED
ONLY 20% REFERRED TO TREATMENT
BY THE JUSTICE AGENCY.
AND THAT THERE IN LIES PART OF
THIS SYSTEM OF CARE OF TENSION
THAT EXISTS IS THE JUSTICE
ACTORS TEND TO DO THE SCREENING
AND ASSESSMENT USING
STANDARDIZED TOOLS BUT THEY
DON'T NECESSARILY ENGAGE IN
REFERRING CLIENTS TO TREATMENT
AND THEY DON'T NECESSARILY FOCUS
ATTENTION ON TRYING TO HELP
CLIENTS INITIATE TREATMENT.
THE FACTORS THAT CONTRIBUTED TO
REFERRALES WASNGEIE
GO INT COMMUNICATIONS
WITH OTHER SERVICE AGENCIES WHEN
THERE WERE ISSUES RELATED TO
COLLABORATIVE PRACTICES.
ALL THOSE INCREASE THE TREATMENT
INITIATION RATES BUT WE HAVE
FOUND IN THE PARTICULAR SYSTEMS
IS THERE IS INCONSISTENCY
BETWEEN THE SERVICE SCREENING
FOR NEEDS AND REQUIREMENTS AND
PUT INTO CASE PLANS, SO THE
INFORMATION FROM STANDARDIZE
SCREENING ASSESSMENT TOOLS IS
NOT NECESSARILY GETTING INTO THE
CASE PLANS, THE CASE PLANS
TYPICALLY REFLECT THE LEGAL
REQUIREMENT AND EVEN THOUGH
THERE'S BEEN AN INCREASE USE TO
CUSTOMIZE GENDER RESPONSIVENESS
AND INSTRUMENTS AND TREATMENT
PROGRAMS THESE HAVEN'T
NECESSARILY TRANSLATED INTO
DIFFERENT REFERRAL STRATEGIES
AND THE TENDENCY OF MOST
AGENCIES ARE TO USE GENERIC
TOOLS.
SO WE HAVE AN ISSUE IN TERMS OF
THE LEGAL SYSTEM IN TERMS OF
WHAT THE ROLES AND
RESPONSIBILITIES ARE FOR THESE
SYSTEMS OF CARE AND THE
EXPECTATION THAT WE HAVE THAT
THE LEGAL SYSTEM WILL ENGAGE
USING STANDARDIZED SCREENING
ASSESSMENT TOOLS TO FOSTER
TREATMENT SERVICES FOR YOUTH AND
WOMEN BUT IN FACT THAT HAS NOT
WHAT IS HAPPENED IN REALITY AND
WHAT WE HAVE SEEN IN MANY
STUDIES OF VARIOUS DIFFERENT
CASE MANAGEMENT MODELS AS WELL
AS STUDIES OF TRYING TO
IMPLEMENT EVIDENCE BASED
PRACTICES WITHIN JUSTICE
SETTINGS.
WE DON'T SEE THOSE THAT RESULT
IN GREATER REFERRAL RATES OR
GREATER TREATMENT INITIATION
RATES.
SO WE HAVE HAD THREE GENERATIONS
OF TRYING TO DEVELOP SYSTEMS OF
CARE.
THE FIRST GENERATION IS I HAVE
BEEN TALKING ABOUT IS A
STANDARDIZE INSTRUMENT CASE
MANAGEMENT PROCESS, WHERE THERE
HAS BEEN EFFORTS TO REALLY FOCUS
ATTENTION ON USING STANDARDIZED
RISK AND NEEDS ASSESSMENT TOOLS,
STANDARDIZED SCREENING TOOLS,
AND TRAINING JUSTICE STAFF ON
CASE MANAGEMENT AND SOME
COGNITIVE BEHAVIORAL TECHNIQUES.
ESSENTIALLY IF YOU LOOK AT THE
LITERATURE, THAT IS RESULTED IN
LOW UPTAKE AND REFERRAL, AND
TREATMENT INITIATION.
THE SECOND GENERATION HAS
FOSTERED ON TRYING TO INTEGRATE
CLINICAL SKILLS WITHIN JUSTICE
ENVIRONMENTS AND FOR THE DIRECT
PURPOSE OF BEING ABLE TO
IDENTIFY WOMEN AND YOUTH THAT
HAVE SOME TYPE OF SUBSTANCE USE
OR MEDICAL NEED.
AND TRYING TO INCREASE THOSE
REFERRALS AGAIN.
SO MOTIVATIONAL INTERVIEWING,
SOME KIPES OF CONTINGENCY
MANAGEMENT, ALL EVIDENCE BASED
PRACTICES, EXPERT MODELS THE
SCREENING BRIEF INTERVENTION
REFERRAL AND TREATMENT MODELS,
SOME OF THE COMPUTERIZED
INTERVENTIONS AND APPLICATIONS.
IN SOME CASES, THESE EFFORTS
HAVE EXPANDED THE REACH BUT
THERE IS LIMITED UPTAKE AND FROM
IMPLEMENTATION LENS WILL IS
QUESTIONS ABOUT THE CAPACITY OF
LEGAL SYSTEMS TO BE -- AND STAFF
THAT WORK IN LEGAL SYSTEMS TO BE
ABLE TO EFFECTIVELY USE THESE
CLINICAL SKILLS.
MORE RECENTLY THERE IS A
MOVEMENT TO CLINICAL PATHWAYS OR
ENHANCE DECISION SUPPORT SYSTEMS
WHERE THE EFFORT IS TO TAKE
INFORMATION FROM SCREENING AND
ASSESSMENT TOOLS AND USE THAT
INFORMATION TO BE ABLE TO TO
BETTER IDENTIFY WHICH TREATMENT
SERVICES ARE BETTER SUITED SO
THIS ADDS TO THE INFORMATION
THAT THE JUSTICE ACTOR HAS BY
ACTUALLY GIVING THEM A DIRECT
PATHWAY IN TERMS OF HOW TO
ADDRESS THE SERVICES THAT YOUTH
NEED OR THAT WOMEN NEED.
SO THESE FOCUS MUCH MORE ON
INTEGRATED SYSTEMS OF CARE, AND
ESSENTIALLY PROACTIVE
INTEGRATION EFFORTS, THAT'S WHAT
I'M GOING TO TALK ABILITY TODAY.
BRIEFLY, A LOT OF WORK IS DONE
ON STANDARDIZE INSTRUMENTS AND
CASE MANAGEMENT STRATEGIES,
ESSENTIALLY WE FIND TOOLS THAT
ARE AVAILABLE DO NOT REALLY
INFLUENCE REFERRAL DECISIONS OR
EFFORTS TO ACTUALLY MONITOR AND
FACILITATE TREATMENT INITIATION.
TO GIVE AN EXAMPLE FROM KATE
ELKINGTON'S PROJECT eCONNECT
STUDY, THIS IS A STUDY TO PUT IN
PLACE A CLINICAL DECISION
PATHWAY FOR YOUTH INVOLVED IN
THE JUSTICE SYSTEM.
THAT PARTICULAR STUDY IS FOCUSED
ON TRYING TO IDENTIFY YOUTH WHO
HAVE HIGH PREVALENCE FOR SUICIDE
IDEIATION OR SOME SUICIDE
RELATED BEHAVIOR.
AT BASELINE FOR THE TEN COUNTIES
THAT PARTICIPATED MANY THE
STUDY, DR. ELKINGTON AND HER
TEAM WHICH I'M INVOLVED WITH AS
CO-PI ESSENTIALLY COLLECTED DATA
THAT DEMONSTRATED THAT THERE WAS
UNMET BEHAVIORAL HEALTH NEEDS
FOR MINORITY GIRLS AS COMPARED
TO WHITE GIRLS THAT INVOLVED IN
THE LEGAL SYSTEM.
AND THAT THERE WAS A LOWER
LIKELIHOOD THAT MINORITY GIRLS
WOULD BE REFERRED TO BEHAVIORAL
HEALTH TREATMENT, DIDN'T SEEM TO
HAVE THE SAME -- HEALTH
DISPARITY DIDN'T SEEM TO OCCUR
WITHIN FOR BOYS BUT IT WAS
DRAMATIC FOR GIRLS.
>> MINUTE 30 SECONDS.
>> I'M SORRY?
>> MINUTE 30 SECONDS.
>> OH.
OKAY.
I APOLOGIZE.
ANOTHER DECISION SUPPORT TOOL
THAT HAS BEEN DEVELOPED IS
CALLED MAPPET.
IN MAPPET WE INTEGRATED
DIFFERENT WAYS OF BEING ABLE TO
DRAW CARE.
TO IDENTIFY DIRECT SERVICES
NEEDED.
SO THIS IS A WEB-BASED SERVICE
AND WE SAW HERE THAT SCREENING
LED TO SOME INCREASE INITIATION
AND CARE BUT IT DID NOT RESULT
IN LONG TERM IMPACT IN TERMS OF
INITIATION OF CARE AND EXPERT
HAS NOT RESULTED IN INITIATION
OF CARE.
SO THE CLINICAL DECISION SUPPORT
TOOLS THAT I REALLY WANT TO
FOCUS MY ATTENTION ON, I DIDN'T
USE MY TIME WISELY IS REALLY, I
WILL DRAW HERE FROM DR.
ELKINGTON'S STUDY.
THIS PARTICULAR TOOL IDENTIFIES
SCREENING ASSESSMENT USING AN
APP AND IDENTIFY THREE DIFFERENT
CLASSES OF PATHWAYS, CLASS 1 IS
YOUTH THAT WERE IN -- IMMINENT
RISK OF SUICIDE, CLASS 2 IS
CRISIS BUT NOT EMINENT AND CLASS
3, THOSE INDIVIDUALS NOT IN
CRISIS.
THIS IS ALL PART OF THE APP
ITSELF IS THE INFORMATION
SCREENING FED INTO THE APP AND
IT ACTUALLY SERVES THE PURPOSE
OF DRIVING WHAT TYPE OF
CONNECTION.
WHAT THIS DID IS YOU ACTUALLY
HAD TREATMENT PROVIDERS AND
JUVENILE JUSTICE STAFF WHO
DEVELOPED THESE PATHWAYS
SPECIFIC TO EACH COUNTY.
GENERAL EFFECTS OF USING THE APP
TOWARD THAT YOU CAN SEE INCREASE
IDENTIFICATION OF YOUTH NEEDED
IN MORE IMMEDIATE CLINICAL
SERVICES, AND GREATER INDICATION
OF LINKAGE TO CARE, PART WAS
PROBATION OFFICERS WERE GIVEN
DIRECTIVES IN TERMS OF WHAT
TYPES OF SERVICES AND WHICH
SERVICE PROVIDERS IN THE
COMMUNITY TO PROVIDE CARE.
WE SAW IN PRELIMINARY RESULTS,
THIS OCCURRED DURING COVID BY
USING THIS PARTICULAR APP WE
WERE ABLE TO INCREASE PERCENTAGE
OF YOUTH, WE DIDN'T SEE AS MANY
SCREENED BUT WE WERE ABLE TO
IDENTIFY INCREASE IN BEHAVIORAL
HEALTH NEEDS, REFERRALS TO
TREATMENT INCREASE AND
INITIATION INTO TREATMENT
INCREASE.
WE WERE ABLE TO ADDRESS HEALTH
DISPARITY FOR MINORITY AND WHITE
GIRLS IN TERMS OF REFERRAL TO
TREATMENT.
SO ANOTHER PRODUCT THAT WE HAVE
DEVELOPED IN THE -- NOT GOING TO
HAVE TIME TO TALK ABOUT TODAY,
IS ACTUALLY THIS EFFORT IN TERMS
OF TRYING TO PROVIDE USING
INFORMATION COLLECTED THROUGH
THE SYSTEM TOOLS IN TERMS OF
BEING ABLE TO IDENTIFY GAPS IN
SERVICE BUS MORE CHEEKILY DIRECT
YOUTH AND WOMEN TO PARTICULAR
PROGRAMS.
SO THE R AND R SIMULATION TOOL
SOMETHING MY TEAM DEVELOPED.
PART OF THE ADVANTAGE OF THAT
AND YOU CAN SEE HERE BRIEFLY, IS
WE WERE ABLE TO GET SYSTEMS TO
MODIFY THE TYPES OF SERVICES
AVAILABLE FOR INDIVIDUALS
INVOLVED IN THE JUSTICE SYSTEM.
AS WELL AS TO IMPROVE THE
QUALITY OF CARE.
SO I RAN THROUGH SOME OF THESE
LINKAGES VERY QUICKLY.
AND I APOLOGIZE FOR NOT USING MY
TIME AS WISELY, BUT I WANT TO
END BY BASICALLY SAYING WE -- A
MOVEMENT AWAY FROM MANUAL DRIVEN
SCREENING ASSESSMENT IS NEEDED.
THAT WE NEED MORE OF THESE
CLINICAL PATHWAYS THAT PROVIDE
DIRECT PROACTIVE PLACEMENT,
PARTICULARLY FOR PEOPLE INVOLVED
IN THE JUSTICE SYSTEM WHERE
JUSTICE ACTORS EVEN THROUGH LOTS
OF TRAINING AND WELL INTENDED
SYSTEM CHANGES STILL HAVE
DEMANDS OF BEING A LEGAL ACTOR.
THAT PLACES LESS EMPHASIS ON THE
IMPORTANCE OF INTERAGENCY
CONNECTION AND DEALING WITH
PEOPLE'S HEALTHCARE NEEDS.
SO WHAT WE HAVE BEEN ABLE TO SEE
FROM SOME NEW CLINICAL PATHWAY
STUDIES IS IMPROVED
IMPLEMENTATION OUTCOMES, RELATED
TO ACCEPTABILITY FEASIBILITY AND
WE HAVE BEEN ABLE TO DEMONSTRATE
REDUCE INEQUITIES IN HEALTH
DISPARITIES.
SO THANK YOU, SORRY FOR TAKING
EXTRA TWO MINUTES.
>> NO WORRIES THANK YOU SO MUCH
FOR SHARING THAT GREAT
INFORMATION.
THANK ALL PANELISTS FOR YOUR
GREAT PRESENTATIONS AND
OUTLINING SOME OF THE SUCCESSES
AND OF COURSE SOME CHALLENGES
THAT Y'ALL HAVE EXPERIENCED IN
YOUR PROGRAM.
SO WHAT I WANT TO WE ARE NOW
TRANSITIONING TO THE PANEL
DISCUSSION SO I WOULD LIKE TO
REMIND THE AUDIENCE THAT YOU CAN
ENTER YOUR QUESTIONS IN THE Q&A
BOX AT THE BOTTOM OF THE SCREEN
ALSO I WOULD LIKE TO ENCOURAGE
PANELISTS TO FEEL FREE TO ENGAGE
EACH OTHER WITH QUESTIONS AND
COMMENTS.
WHILE WE WAIT TO HEAR FROM THE
AUDIENCE, I WOULD LIKE TO START
BY ASKING THE PANELISTS ABOUT
IMPACT OF COVID, HOW HAS COVID
IMPACT YOUR PROGRAM?
AND ARE THERE MODIFICATIONS OR
ADJUSTMENTS THAT YOU HAVE TO
MAKE DUE TO COVID RESTRICTIONS
THAT YOU FOUND BENEFICIAL AND
PLAN TO SUSTAIN AND CONTINUE?
>> I CAN TALK ABOUT THAT
INITIALLY.
I KNOW I DID NOT GIVE A LOT OF
DETAIL OF OUR INTERVENTION SO I
WILL BRIEFLY DESCRIBE WHAT WE
ARE DOING AND HOW MODIFIED FOR
COVID. NOT SURPRISINGLY COVID
HAD IMPACT WE ARE RUNNING A
STUDY AND COULDN'T RECRUIT FOR
THE -- THE IRB SHUT DOWN, LOTS
OF THINGS HAPPENED AT BEGINNING
OF COVID.
SIMILAR TO FAYE WAS TALKING
ABOUT INDIVIDUALS GETS
ASSESSMENT SO WE ARE IDENTIFYING
OTHER CO-MORBID CONDITIONS AT
SAME TIME.
AS WELL AS ADHERENCE TO
MEDICATION.
AFTER THEY DO THIS COMPUTER
DELIVERED INTERVENTION WHICH
FOCUSES ON ALCOHOL BUT THEN ALSO
PROVIDES MORE INFORMATION ON THE
LINK BETWEEN SUBSTANCE USE AN
TRAUMA, BECAUSE WE LEARN FROM
INTERVIEWS INDIVIDUALS OFTEN
AREN'T MAKING THAT CONNECTION.
AND THEY ARE CONNECTED TO OUR
COMMUNITY HEALTH WORKER WHO
WORKS WITH THEM TO GET THEM
RESOURCES, SO THAT INCLUDES
MENTAL HEALTHCARE OTHER
SUBSTANCE USE CARE AND TACKLING
THINGS LIKE FOOD INSECURITY.
SO WHAT I WOULD SAY MANY TERMS
OF COVID, IT WAS CLEAR WE WERE
GOING TO HAVE TO MOVE MORE LESS
IN PERSON BASED INTERVENTION AND
TRY TO FIGURE WHAT WE WERE DOING
THROUGH TELEPHONE, ZOOM, OTHER
THINGS.
WHAT I WOULD SAY IS IN OUR
CLINIC MANY DO NOT HAVE INTERNET
ACCESS SO YOU COULDN'T TAKE THAT
FOR GRANTED.
SO A LOT WAS MOVED TO PHYSICAL
TELEPHONE, CELL PHONE OPPOSED TO
DO SOMETHING BECAUSE CELL PHONE
DOESN'T HAVE ENOUGH WIFI TO DO
VIDEO CALL.
WE HAD TO ADAPT AND LEARN TO
TEACH OUR COMMUNITY HEALTH
WORKER HOW TO BEST USE HER
SKILLS VIA TELEPHONE, IF YOU
CAN'T USE VIDEO.
AND WE CAN STILL WE DO STILL
ALSO DO NOW BECAUSE THINGS
OPENED UP MORE WE ARE DOING IN
PERSON MEETINGS BUT USUALLY THE
FIRST MEETING.
I THINK FOR US THE BIGGEST
CHANGE WAS MOVING FROM MORE LIKE
YOU ENVISION SOMETIMES THIS
PERSON IS GOING TO WALK THEM TO
EVERY APPOINTMENT THEY ARE GOING
TO GO TO.
TO THINKING HOW WE CAN FURTHER
YOU ARE USE OF TECHNOLOGY AMONG
A GROUP OF INDIVIDUALS NOT USING
TECHNOLOGY TO MUCH EXTENT PRIOR
TO THE PANDEMIC.
COVID PROVIDED MANY CHALLENGES.
>> I THINK FROM THE LEGAL SYSTEM
ONE OF THE BENEFITS THAT CAME
FROM COVID WAS THE LEGAL SYSTEM
ACTUALLY HAS LESS INTAKE.
ARRESTS WERE DOWN THOUGH THAT IS
NOW BEING REVERSED.
THE ADVANTAGE WAS ABLE TO
ACTUALLY HELP PEOPLE CONNECT TO
SERVICES IN THE COMMUNITY FOR
PEOPLE WHO HAD NEEDS.
BUT WHAT WE HAVE SEEN WITHIN THE
LEGAL SYSTEM IS THIS NEW
INTEREST IN SOME OF THESE
CLINICAL SUPPORT SERVICES, APPS
THAT ARE AVAILABLE, OTHER TYPES
OF TELEHEALTH, THAT IS AN
ADVANTAGEOUS BUT AS DR. CHANDER
INDICATED PART OF THE ISSUE IS
PEOPLE DON'T HAVE THE EQUIPMENT
TO BE ABLE TO DO THAT.
A LOT OF LEGAL AGENCIES
PROBATION PAROLE AGENCIES HAVE
DISTRIBUTED CELL PHONES SO
PEOPLE CAN GET ACCESS TO SOME OF
THOSE SERVICES.
FROM OUR PERSPECTIVE COVID IS
CHALLENGING BECAUSE WE HAVE
BEENN'T BEEN ABLE TO GO TO
FACILITIES SINCE START OF COVID
SO WE DID HAVE TO SHIFT
TELEHEALTH SO ALL OUR PHONE
CONTACT, ALL PHONE CONTACT NOW A
LOT ARE STILL INCARCERATED, IT
DOES IMPACT ON ENGAGEMENT.
SO I LOOK TO THE DAY WE CAN GO
BACK INSIDE OUR JAILS AND
PRISONS.
AND THEN AS FAR AS CLINICAL
SERVICES, WE ARE STILL PROVIDING
THROUGH THE HYBRID MODEL WE ARE
SEEING PEOPLE IN PERSON, ARE
DOING TELEHEALTH AND WE FIND
THAT THAT IS BENEFICIAL.
THERE IS ALSO SOME CHANGES WITH
REGARD TO STANDARDS OF CARE AND
WHAT IS POSSIBLE PRESCRIBING
THAT.
SO YOU CAN DO HOME INDUCTION NOW
THROUGH TELEHEALTH.
THAT IS BEING GOOD TOOL TO GET
PEOPLE ON A MAP AND QUICKLY IN
THROUGH THE ERA OF COVID.
IN GENERAL THE OTHER SPEAKERS
ARE IDENTIFYING THERE IS SOME
TECHNOLOGY CHALLENGES WITH
PEOPLE HAVING ACCESS TO WIFI,
HAVING ACCESS TO CELL PHONES,
DATA PLANS.
SO I AM LOOKING FORWARD TO THE
DAY WHEN WE NO LONGER HAVE COVID
RESTRICTIONS.
>> I THIS I WE ALL ARE.
DR. MCKEE I HAVE A QUESTION
SPECIFICALLY FOR YOU.
SOME OF THE KEY TAKE AWAYS YOU
IDENTIFIED OF HIGHER RISK OF
SUBSTANCE USE, GREATER
PSYCHIATRIC CO-MORBIDITIES LESS
LIKELY TO ENGAGE IN PRIMARY
HEALTHCARE, BUT THERE ARE
ENGAGED IN TREATMENT IN THAT AT
THE SAME RATES AS MEN.
THEY ARE HOUSED AND EMPLOYED,
HAVE SIMILAR RATES OF TREATMENT
COMPLETION RECIDIVISM AS MEN,
AND ENGAGE IN SIMILAR THAT
EXACERBATE -- COMPLETION OF RATE
OF RECIDIVISM BETWEEN WOMEN AND
MEN?
>> WHAT WE KNOW SO FAR IS LOOKED
AT I CAN SAY THAT THAT WOMEN
VERY MUCH IDENTIFY INDIVIDUAL
TREATMENT AS KEY FOR THEM, VERY
OFTEN WE SEE THAT THAT WOMEN
MIGHT BE IN TREATMENT SOME
MONTHS BEFORE THEY START TALKING
TRAUMA AND REALLY STARTING TO
DEAL WITH THE IMPACT OF TRAUMA
HAS HAD ON THEIR ADDICTION.
AND LIFE IN GENERAL.
I THINK THAT PROVIDING
INDIVIDUAL THERAPY IS KEY FOR
TRAUMA INFORMED CARE.
I THINK IN GENERAL WHAT WE SEE
IS THAT WOMEN GET BIGGER DOSE OF
TREATMENT SO THEY STAY IN
TREATMENT LONGER AND JUST IN OUR
VERY ROUGH COST EFFECTIVENESS
ANALYSIS, IN GENERAL COSTING US
ABOUT 4,000 TO TREAT A MAN AND
CLOSER TO 7,000 FOR A WOMAN.
THAT IS COMPARISON TO IN
CONNECTICUT IT COSTS $52,000 A
YEAR TO INCARCERATE SOMEONE.
SUBSTANTIALLY LESS POPULATION.
>> YEAH.
HOW CAN YOUR FINDINGS BE USED TO
INFORM HEALTH SERVICES AND
SUBSTANCE USE TREATMENT TO
SUPPORT RECOVERY ANDEN RETENTION
AND RETENTION AND CARE?
SPECIFICALLY GENDER SPECIFIC
INTERVENTIONS?
>> I HI THE LINKAGES BETWEEN
STATE PARTNERS AND TREATMENT
SETTINGS IS KEY.
IT TAKES A LOT OF WORK TO DO THE
WARM HAND OFF BETWEEN DEPARTMENT
OF CORRECTIONS AND I THINK TRUE
OF MOST DEPARTMENT OF
CORRECTIONS, THEY ARE BIG AND
COMPLEX SYSTEMS AND IT CAN BE
DIFFICULT TO DO -- GET THAT WARM
HAND OFF INTO COMMUNITY
TREATMENT AND PEOPLE DO FALL BY
THE WAYSIDE, IN PARTICULAR WE
FINDS THE HARD TO ENGAGE THOSE
SO THAT MEANS THEY COMPLETED
THEIR TIME, NO COMMUNITY
SUPERVISION, ONCE RELEASED FROM
INCARCERATION AND THAT IS A
POPULATION THAT WE FIND REALLY
DIFFICULT TO ENGAGE.
WITH REGARD TO GENDER SPECIFIC
PIECE, TRAUMA INPERFORMED CARE
IS KEY, KEY IS ALSO ADDRESSING
THE OTHER PSYCHIATRIC
CO-MORBIDITIES IN A INTEGRATED
MANNER WITH ADDICTION AND
PHYSICAL HEALTHCARE, NOTHING
WORKS IN ISOLATION.
I WILL ASK DR. TAXMAN TO CHIME
IN, THINKING INSURANCE TREATMENT
INITIATION LINKAGE TO DIFFERENT
SERVICES, SPECIALLY AMONG THE
FOLKS INCARCERATED AND ABOUT TO
BE RELEASED.
RECONDUCTED INTO THE COMMUNITY.
SO CAN YOU TALK ABOUT THAT?
>> SO EVERYONE IS AWARE, IF A
PERSON IS INCARCERATED WHETHER
JAIL OR PRISON SETTING THEY ARE
NOT ELIGIBLE TO RECEIVE MEDICAID
ASSISTANCE.
THAT IS PART OF THE CURRENT LAW.
NOT LIKELY TO BE PASSED LAW, THE
BUILD BACK BETTER DID HAVE A
MODIFICATION TO THAT TO ALLOW
PEOPLE TO GET INSURANCE 30 DAYS,
AS WE LEARN LAST NIGHT THAT LAW
DOESN'T SEEM TO BE MOVING
FORWARD.
SO THAT'S ONE BARRIER.
IS THAT LOCAL JAILS AND PRISONS
BASICALLY LARGELY RESPONSIBLE BY
CONSTITUTION PROVIDED FOR
MINIMUM STANDARD OF CARE.
UNFORTUNATELY THAT STANDARD DOES
NOT INCLUDE MEDICATION FOR
OPIOID USE DISORDER ALCOHOL USE
DISORDER THOUGH SOME STATES LIKE
MASSACHUSETTS ENACTED A LAW THAT
REQUIRES JAILS TO PROVIDE
MEDICATION.
SO FUNDING IS A HUGE ISSUE.
ANOTHER IS WORK FORCE ISSUES.
OBVIOUSLY WE HAVE A DERTH OF
APPROPRIATE WORK FORCE STAFF IN
THE U.S. IT IS HARDER HIT WITH
INCARCERAL SETTINGS WHERE THOSE
ARE NOT NECESSARILY THE MOST
PLEASANT SETTINGS TO PROVIDE
CARE.
THERE HAVE BEEN SOME EFFORTS
LATELY TO LOOK AT DOING
TELEHEALTH SERVICES.
WITHIN SETS TO PROVIDE MEDICAL
CARE SERVICES BUT THOSE ARE
EXPERIMENTAL AT THIS POINT.
THE BIGGEST ISSUE ABOUT THE
HEALTH SYSTEM AN INTERACTION
WITH THE LEGAL SYSTEM FOR THE
MOST PART BALANCE IS PUTTING --
BASICALLY HAVING THE LEGAL AS
MUCH INITIATE THAT'S THE
REFERRAL PROCESS THAT I WAS
REFERRING TO.
THE QUESTION DR. JOHNSON HASN'T
CHAT BOX IS ABOUT ARE THERE
OTHER MODELS IN WHICH THE
HEALTHCARE SYSTEM COULD DO SOME
OF THOSE INITIATIONS AND
SCREENING AT THE LOCAL LEVEL
JAIL CAN BE ACCOMPLISHED WITH
PARTNERSHIPS BETWEEN HEALTHCARE
PROVIDERS AND LO L DA JAILS,
THOSE LOCAL SYSTEMS ARE -- BEGIN
IN THE JAIL SYSTEM LIKE WHAT DR.
MCKEE WAS TALKING ABOUT IN HER
CONNECTICUT FROM APOLOGETIC.
THOSE ARE FAR AND FEW BETWEEN.
OUR BIGGEST BARRIER RIGHT NOW IS
ACTUALLY THE FUNDING ISSUE AND
THE COVERAGE OR LACK OF COVERAGE
FROM MEDICAID ASSISTANCE FOR
PEOPLE WHO LIVE IN MEDICAID
ELIGIBLE STATES, EXPANDED
STATES.
THERE WAS ANOTHER QUESTION IN
THE CHAT BOX THAT HAD TO DO
WITH eCONNECT PROJECT AND HOW
WE WERE ABLE TO DEAL WITH THE
HEALTH -- REDUCING HEALTH
DISPARITY.
I WOULD LIKE TO ADDRESS THAT
BECAUSE I THINK THAT'S EXCITING
FOR US.
UNFORTUNATELY WHEN WE HAVE
PROBATION PAROLE OFFICERS WHO
ARE TRAINED TO USE AN ASSESSMENT
TOOL BUT NOT NECESSARILY
FAMILIAR HOW TO USE THAT
INFORMATION TO MAKERRINGS FOR
CARE HENCE WE HAVE PROBLEM OF
LACK OF REFERRALS.
BUT COMPLY CATTED BY THAT ARE
THE INTERPERSONAL DYNAMICS THAT
OCCUR DURING INTAKE AND
ASSESSMENT PROCESSES IN WHICH
JUSTICE ACTORS MAKE DECISIONS
ABOUT PEOPLE'S THEIR
PRESENTATION OF SELF AND WHAT WE
HAVE FOUND IS PART OF THE
REASONS WE ARE MOVING TOWARD
STANDARDIZED INSTRUMENTS IS YOU
CAN DEAL WITH IMPLICIT BIASES
THAT OCCUR ON THE PART OF SOME
OF THE JUSTICE ACTORS.
SO THE eCONNECT SYSTEM IN THIS
PARTICULAR CASE IS AN EXAMPLE
WHERE THE STANDARDIZE ASSESSMENT
PROTOCOL THAT INVOLVED USING
THIS APP DIRECTED IDENTIFICATION
INDIVIDUALS IN TERMS OF DEGREE
OF PRICES SERVICES RELATED TO
SUICIDE, BASICALLY HELPED THE
OFFICER TO RETHINK SOME OF THE
JUDGMENTS THEY WERE MAKING ABOUT
YOUTH OR SEVERITY OF THE
INFORMATION PROVIDED.
SO IT IS TO SOME DEGREE
MECHANISM HERE IS REALLY DEALING
WITH IMPLICIT BIAS.
AND PROVIDING DIRECTIVE
INFORMATION THAT OFFICERS CAN
USE ABILITY URGENCY PROVIDING
DIFFERENT TYPES OF CARE.
>> THANK YOU FOR THAT.
THERE IS ANOTHER QUESTION FOR
ALL THE PANELISTS DR. TAXMAN WE
SEE DATA OFTEN SHOWING NEEDS OF
NON-WHITE WOMEN SEEM TO BE
IGNORED.
THEY ARE IN THE LEAST AMOUNT
DRESSED TONED DOWN WHAT ARE THE
OPERATING MECHANISMS TO DRIVE
THIS BIAS?
SPECIFIC THINGS AFFECTING ACCESS
AND PERSONAL DYNAMICS BETWEEN
PROVIDERS AND PATIENTS BIAS AND
WHAT IS COMMUNICATED ABOUT THE
PATIENT, ET CETERA.
>> I THINK I RAISED ONE WHICH IS
IMPLY SIT BIAS, I WOULD SAY
ANOTHER DYNAMIC THAT OCCURS
BETWEEN LEGAL SYSTEMS ACTORS AND
CLIENTS WHO COME IN, IS THE
LEGAL SYSTEM ACTORS ARE
OVERWHELMED WITH THE COMPLEXITY
OF NEEDS OF INDIVIDUALS AND
THEREFORE THE TENDENCY IS JUST
TO FALL BACK ON TRADITIONAL
MODEL, I AM HERE TO TREAT THE
CRIME AND NOT THE PERSON.
HERE TO ADDRESS THE CRIME NOT
THE PERSON.
SO PART IS A ROLE DEFINITION,
ANOTHER MECHANISM I THINK IS
THAT ESSENTIALLY YOU HAVE THESE
-- BECAUSE JUSTICE SYSTEM
DOESN'T RECOGNIZE THEMSELVES AS
SERVICE PROVIDER, YOU HAVE THE
LEGAL SYSTEM THAT IS ALWAYS
CONSTANTLY FOCUSING IN ON WHAT
IS THE ROLE IN THE LEGAL SYSTEM.
SO THAT IS WHY THESE SYSTEMS
MODELS ARE REALLY IMPORTANT.
>> ANY OTHER --
>> I WOULD ALSO SAY THAT WE NEED
TO FOCUS ON STIGMA AND IN THE
POPULATION I TREAT THERE IS
MULTIPLE SOURCES OF STIGMA,
STIGMA FROM ADDICTION, CRIMINAL
JUSTICE HISTORY, AND CLIENTS
THEMSELVES DO IDENTIFY STIGMA AS
BARRIER TO SUCCESSFUL RECOVERY.
I KNOW THERE IS STARTING TO BE
WORK ABOUT ACTUALLY TRAINING
PEOPLE TO OVERCOME THEIR STIGMA
AND BIASES.
I KNOW ONE J COIN PROJECT
FOCUSED ON DEPARTMENT OF
CORRECTION WORKERS AND PROBATION
PAROLE OFFICERS SO THAT IS
SOMETHING WE NEED TO TAKE HEAD
ON.
>> TELLING MORE -- KELLY MOORE
AT EASTERN TENNESSEE UNIVERSITY,
HAS A STIGMA INTERVENTION WE ARE
TESTING OUT. FOR JUSTICE
WORKERS.
WHICH IS REALLY EXCITING.
SO I WASN'T SURE IF THAT WAS WHO
YOU WERE REFERRING.
>> THAT WAS WHO -- KELLY DID A
POST DOC WITH ME.
>> I'M MENTORING HER NOW.
SHE IS AWESOME.
SHE DEVELOPED THIS WONDERFUL
CURRICULUM THAT SHE'S DELIVERING
AS PART OF HER J COIN BRANDS.
>> THANK YOU.
WE HAVE TIME FOR ONE MORE
QUESTION.
THIS WAS FROM STEVEN SMITH.
HE WORKS -- STEVEN SMITH WORK AT
-- AT OUR LOWER BUCKS TREATMENT
24 HOUR ASSESSMENT PROGRAM.
THEY ALSO HAVE A B CARE
PROPONENT THAT DEALS WITH
OVERDOSE OF -- THE LOWER BUCKS
HOSPITAL CALL US WHEN AN
OVERDOSE OCCURS WHERE OVERDOSE
VICTIM SURVIVES THE EVENT.
AS A FAMILY RECOVERY SPECIALIST
MY ROLE IS TO TALK WITH OVERDOSE
VICTIM THAT OCCURS IN
INDIVIDUALS TO GET INVOLVED IN
TREATMENT.
HOW MUCH OF THIS TYPE OF SUPPORT
IS PROVIDED AND WHERE.
STEVEN SAYS THEY KNOW IT HAPPENS
IN PA IN PENNSYLVANIA OR
PHILADELPHIA.
DID ANYONE WANT TO ANSWER THAT
QUESTION?
>> I DON'T KNOW MUCH ABOUT THE
FAMILY, I JUST WROTE TO STEVEN,
BUT I WOULD BE REALLY INTERESTED
IN LEARNING MORE ABOUT THE
FAMILY RECOVERY SPECIALIST.
THE SPARK IT HAS CAUSE FOR ALLOW
THE CHAT TO KEEP GOING.
I DO ENCOURAGE THE PANELIST IF
YOU CAN TO IMPORTANT IF YOU ARE
ABLE TO RESPOND IN THE CHAT YOU
CAN WRITE BACK IN THE CHAT IF
YOU WANT TO RESPOND TO SOME OF
THOSE COMMENTS OR QUESTIONS.
SO NOW I WILL TURN IT OVER TO
MARRAH FOR THE NEXT SESSION.
>> MANY THANKS AGAIN, SESSION
FOUR SPEAKERS WHO CONTINUE FROM
SESSION THREE YESTERDAY MAKING
THE CASE FOR CONTINUUMS OF CARE.
BY PROVIDING EXAMPLES OF ACTIVE
PROGRAMS.
WITH TODAY FOCUS ON HIGH RISK
WOMEN AND THOSE WHO INTERFACE
WITH THE CRIMINAL JUSTICE
SYSTEM.
OUR FIRST PRESENTATION COVERED
THE SHARP COMMUNITY OF
PARTICIPATORY RESEARCH PROGRAM
THAT WAS DESIGNED TO ADDRESS
ALCOHOL USE DISORDER IN WOMEN
WITH CO-OCCURRING HEALTH
CONDITIONS INCLUDING MENTAL
HEALTH DISORDERS AND WOMEN WITH
HIV.
AS ALCOHOL USE INCREASE RISK FOR
INFECTION AND REDUCE MEDICATION
ADHERENCE FOR THOSE WHO ARE
INFECTED, THE PROGRAMS WERE
TAILORED TO WOMEN TO MEET THEIR
NEEDS TO REDUCE THEIR RISK.
THAT WERE ALSO RELEVANT AND
IMPACTFUL TO THE COMMUNITY BASED
ON TYPES OF ISSUES WOMEN WERE
EXPERIENCING IN THEIR LIVES.
SECOND TALK DISCUSSING
CONTINUUMS OF CARE FOR MODEL
REENTRY INTO SOCIETY FOR WOMEN
AFTER INCARCERATION.
AND THIS PROGRAM WAS DESIGNED TO
REDUCE RETURN TO INCARCERATION
BY COMBINING MENTAL HEALTH CARE
PRIMARY CARE AND PEER MENTOR
SUPPORT IN IN A COLLABORATIVE
CARE MODEL CALLED THE LIVING
FREE PROGRAM.
SERVICES PROVIDED MAP DURING THE
END OF INCARCERATION PERIOD
WHICH INCLUDED ADDICTION
COUNSELING, PEER MENTORING TO
MOTIVATE THEM TO GET TREATMENT
AT RELEASE, AND PLAN OF
INTEGRATED CARE INTO THE CLINIC
TO CONTINUE THERAPY TAYLORED TO
INDIVIDUAL WOMEN NEEDS.
OUR FINAL SPEAKER CONTINUED THE
DISCUSSION FOR WOMEN INTERFACING
WITH THE CRIMINAL JUSTICE SYSTEM
COVERED SEVERAL TOOLS AND
PROGRAMS TO GET WOMEN AND GIRLS
INTO CARE FOR THEIR HEALTH
ISSUES.
A GAP WAS REALLY FRAMED AROUND
HOW WE LINK PEOPLE WITH THE
SERVICES WITHIN THE COMMUNITY OR
WHILE INCARCERATED THAT
INTERFACE WITH THE CRIMINAL
JUSTICE SYSTEM.
REFERRAL AND INITIATION OF CARE
WERE FOUND TO BE KEY TO RECEIPT
OF THESE SERVICES.
AN EXAMPLE IS PROVIDED WHERE
INCARCERATED GIRLS LESS LIKELY
TO RECEIVE MENTAL HEALTH
SERVICES THAN BOYS.
AND THIS DISPARITY WAS INCREASED
FROM MINORITY GIRLS SO BARRIER
THERE TO REFERRAL AND INITIATION
WAS SYSTEMIC ISSUE WHERE THESE
GIRLS' NEEDS ARE IGNORED.
THIS SPEAKER PROVIDED EXAMPLES
WHERE WOMEN FROM MARGINALIZED
COMMUNITIES, REALLY NEED A
COMPREHENSIVE INTEGRATED SUPPORT
TO PREVENT FUTURE RISK FROM
CO-OCCURRING CONDITIONS.
I HOPE WE WILL CONTINUE TO THINK
OF THESE CRITICAL GAPS AND NEEDS
AS WE CONTINUE THROUGH OUR
SESSIONS TODAY.
AND AT THE DISCUSSION AT THE END
OF TODAY.
PARTICULARLY HOW CAN WE BEGIN TO
ADDRESS STRUCTURAL RACISM HANDLE
IMPLICIT BIAS.
SO AT THIS TIME WE ARE GOING TO
TAKE A SHORT BREAK BEFORE
CONTINUING INTO OUR LAST
SCIENTIFIC SESSION FOR TODAY.
>> THIS IS SESSION
FIVE BUILDING THE INFRASTRUCTURE
FOR INTEGRATED HEALTHCARE
SYSTEMS FOR WOMEN AND GIRLS
WHERE WE WILL DISCUSS COMMUNITY
ENGAGEMENT, ADDRESSING POLICY
FINANCING AND WORK FORCE
DEVELOPMENT.
REQUIREMENTS.
THIS SESSION WILL BE MODERATED
BY DR. ROACH.
LY TURN IT TO HER NOW.
>> GOOD AFTERNOON, WELCOME TO
FIFTH FINAL SESSION OF WORKSHOP
ENTITLED BUILDING THE
INFRASTRUCTURE FOR INTEGRATIVE
HEALTHCARE SYSTEMS FOR WOMEN AND
GIRLS.
ADDRESSING COMMUNITY ENGAGEMENT,
POLICY, FINANCING DATA
INTEGRATION AND WORK FORCE
DEVELOPMENT REQUIREMENTS.
I SERVE AS MEDICAL PROJECT
OFFICER WITH NATIONAL INSTITUTE
ON ALCOHOL ABUSE AN ALCOHOLISM.
IT IS MY GREAT PLEASURE AND
PRIVILEGE TO INTRODUCE OUR
SPEAKERS FOR THIS SESSION WHO
WHILE LISTED LAST OBJECT PROGRAM
WILL BE ADDRESSING SOME OF THE
MOST CRITICAL ISSUES HIGHLIGHTED
BY THIS WORKSHOP.
I'M SURE EVERYONE IN ATTENDANCE
WOULD AGREE IN THE ABSENCE OF
CRITICAL INFRASTRUCTURE, THAT IT
INCLUDES AT LEAST FIVE ESSENTIAL
ELEMENTS MANY THE TITLE OF THIS
SESSION TO DREAM OF BUILDING
UNITIED SYSTEMS OF HEALTHCARE TO
ADDRESS COMMON CO-MORBIDITIES IN
WOMEN AN GIRLS, IS TO DREAM THE
IMPOSSIBLE DREAM.
ONE OF OUR SCHEDULED SPEAKERS
DR. GAIL DAUMIT IS NO LONGER
ABLE TO PARTICIPATE BECAUSE OF A
FAMILY EMERGENCY.
WE WISH HER AND HER FAMILY WELL.
WE DO HAVE THREE DISTINGUISHED
PANELISTS TO LEAD THIS AFTERNOON
DISCUSSION AND IN THE INTEREST
OF TIME MY INTRODUCTIONS WILL BE
BRIEF.
BUT I DRAW YOUR ATTENTION TO THE
FULL LENGTH BIOS IN YOUR PROGRAM
BOOK.
FIRST WE WILL HEAR FROM DR.
CAITLIN CROSS BARNET, SOCIAL
SCIENCE RESEARCH ANALYST AT THE
CENTER FOR MEDICARE AND MEDICAID
INNOVATION RESEARCH AND
EVALUATION GROUP AND HAS
PARTICULAR EXPERTISE IN
QUALITATIVE AND MIXED METHODS
RESEARCH.
HER PRIOR PROJECTS INCLUDED
STRONG START FOR MOTHERS AND
NEWBORNS AND THE HEALTHCARE
INNOVATION AWARDS, AND HER
CURRENT PROJECTS ARE INTEGRATED
CARE FOR KIDS, AND THE MATERNAL
OPIOID MISUSE MODEL.
IN ADDITION TO REPRODUCTIVE AND
PEDIATRIC HEALTH, SHE FOCUSES ON
BEHAVIORAL HEALTH SUBSTANCE USE
DISORDERS, CARE TRANSFORMATION,
AND HEALTH EQUITY.
IN TODAY'S SESSION DR. CROSS
BARNET WILL PLACE THE SPOTLIGHT
ON COMMUNITY ENGAGEMENT,
PROVIDING AN OVERVIEW OF THE
INTEGRATED CARE FOR KIDS, AND
MATERNAL OPIOID MISUSE MODELS.
NEXT IS MS. RYAN ARGENTIERI,
DEPUTY DIRECTOR OFFICE OF
TECHNOLOGY AT THE OFFICE OF
NATIONAL COORDINATOR FOR HEALTH
IT.
IN THIS POSITION MS. ARGENTIERI
SUPPORTS ONS VERIFICATION
TESTING STANDARDS AND TECHNOLOGY
ANALYSIS PORTFOLIOS.
SHE LEADS COORDINATION OF CROSS
FUNCTIONAL PROGRAMS PROMOTING
INTEROPERABILITY AND STANDARDS
HARMONIZATION FOR HIGH PRIORITY
AREAS SUCH AS PUBLIC HEALTH DATA
MODERNIZATION AND SOME
DETERMINANTS OF HEALTH.
PARTNERING WITH MS. ARGENTIERI
FOR THIS PRESENTATION WILL BE
MS. JAWANNA HENRY WHO SERVES AS
ANALYST AND SOCIAL DETERMINANTS
OF HEALTH OR SODH -- SDOH LEAD.
FOR THE OFFICE OF TECHNOLOGY,
WITHIN THE OFFICE OF THE
NATIONAL COORDINATOR FOR HEALTH
IT.
WHERE SHE LEADS SEVERAL DATA
INTEGRATION INITIATIVES, THAT
FOCUS ON THE DEVELOPMENT AND
ADVANCEMENT OF STANDARDS TO
SUPPORT EXCHANGE AND USE OF DATA
AS THE SDOH LEAD, SHE CONDUCTS
STRATEGIC PLANNING AND
COORDINATION TO ALIGN WITH THE
DEVELOPMENT OF STANDARDS THAT
SUPPORT THE EXCHANGE OF SDOH
DATA AND EXPLORES INNOVATIVE USE
OF THOSE DATA.
ADDITIONALLY SHE CO-LEADS THE
BEHAVIORAL HEALTH PORTFOLIO
WITHIN THE OFFICE OF TECHNOLOGY
INCLUDING ELECTRONIC CLINICAL
DECISION SUPPORT, THE ADVANCING
PRESCRIPTION DRUG MONITORING
PROGRAM, AND ELECTRONIC HEALTH
RECORD INTEGRATION.
IN TODAY'S SESSIONS IN
ARGENTIERI AND MS. HENRY WILL
FOCUS THE SPOTLIGHT ON DATA
SCIENCE DEVELOPING THE
STRATEGICALLY COORDINATED
REGISTRY NETWORK OR CRN FOR
WOMEN'S HEALTH TECHNOLOGIES.
THANK YOU, I'M GETTING A MESSAGE
HERE OVER -- WELCOME, THANK YOU
TO OUR PANELISTS WE WILL JOIN
NOW WITH DR. CROSS BARNET.
>> THANK YOU, DR. ROACH.
ARE YOU PUTTING UP MY SLIDES?
>> WE'LL DO THAT.
>> GREAT.
THANK YOU.
>> THANK YOU SO MUCH.
DR. ROACH GAVE ME A THOROUGH
INTRODUCTION.
I WANT TO SAY I WILL DEFINITELY
TALK ABOUT INTEGRATIVE CARE FOR
KIDS AND OPIOID MISUSE MODEL BUT
I WILL START OFF WITH MOTHERS
AND NEWBORN WHICH TAUGHT LESSONS
IN THE WAYS WE SHAPE THE OTHER
PROGRAMS.
AND ALSO HAS RESULTS UNLIKE THE
OTHER TWO MODELS WHICH ARE JUST
GETTING STARTED.
FOR MOTHERS AND
MANY U BOURNS HAVE THE GOAL
PREVENTING PRE-TERM BIRTH, LOW
BIRTH WEIGHT IMPROVING BIRTH AND
HEALTH OUTCOMES FOR PARENTS AND
INFANTS AND LOWERING COSTS.
AND THE PROGRAM OPERATED FROM
2013 THROUGH 2017 SERVING 46,000
PREGNANT MEDICAID BENEFICIARIES,
PARTICIPANTS WERE BLACK AND
HISPANIC WITH 40% AFRICAN
AMERICAN AND 30% HISPANIC FROM
VARY COURTHOUSE BACKGROUNDS,
THAT WAS PARTIALLY INTENTIONAL
BECAUSE THE INTENT OF THE MODEL
IN REDUCING PRE-TERM BIRTH WAS
TARGET HIGHER RISK POPULATIONS
AN ESPECIALLY AMONG AFRICAN
AMERICAN WOMEN WE KNOW THERE IS
A LARGE DISPARITY IN PRETERM
BIRTH RATES. SO WE TESTED THREE
MODELS OF PRE-NATAL CARE, ONE
WAS TESTING CARE IN BIRTH
CENTERS AND IT IS IMPORTANT TO
REALIZE YOU DON'T HAVE GIVE
BIRTH IN A BIRTH CENTER TO GET
CARE.
SO THAT WAS TESTING IN THE
MIDWIFERY MODEL WHICH WAS
ENHANCED WITH PEER COUNSELING.
THE OTHERS WERE PRE-NATAL CARE
AND MATERNITY CARE HOMES SO
GROUP CARE BASICALLY WENT
ACCORDING TO CENTER AND
PREGNANCY MODEL FACILITATED
DISCUSSION ALONG WITH THE
PRE-NATAL VISIT SO NOT JUST A
QUOTE UNQUOTE CLASS BUT
INCURRENT RATED PREPRE-NATAL
CARE TO EDUCATION COMPONENT,
PEER SUPPORT AND MATERNITY CARE
HOMELESS WHICH OFFERED MA WHAT
YOU CONSIDER STANDARD CLINICAL
CARE MODEL BUT ENHANCED WITH
CARE COORDINATION AND SOMETIMES
WITH SOME OTHER SERVICES SUCH AS
NUTRITION COUNSELING OR ENHANCE
ACCESS TO BEHAVIORAL HEALTH
PROVIDERS.
THERE WERE 27 AWARDEES IN TOTAL
THAT HAD 211 CARE SITES IN 32
STATES, WASHINGTON D.C. AND
PUERTO RICO, YOU CAN SEE HERE
THEY ARE CONCENTRATED SOMEWHAT
IN THE SOUTH EAST BECAUSE THAT
IS AN AREA WITH HIGH PRE-TERM
BIRTH RATES SO GREEN SITES ARE
BIRTH CENTER CARE AND YELLOW
PRE-NATAL CARE AND BLUE
MATERNITY CARE HOMES AND A
COUPLE OFFERING MORE THAN ONE
MODEL OF CARE WITHIN THEIR
PROGRAMS.
NEXT SLIDE.
WE GOT PARTICIPANTS HAD HIGH
LEVELS OF NEED PROBABLY NOT
SURPRISING TO ANYBODY.
SO LOTS OF MEDICAL RISK FACTORS
PEOPLE COMING IN WITH
PRE-EXISTING DIABETES OR
HYPERTENSION OR HAVING AD A
PRIOR PRE-TERM BIRTH, OVERWEIGHT
AND OBESITY, DEPENDING ON THE
MODEL BETWEEN 25 AND 48% PEOPLE
COMING IN BMI 30 OR HIGHER LOW
LEVELS OF EMPLOYMENT OR
EDUCATION.
MOST PEOPLE OR THAT MAJORITY, I
WOULDN'T SAY MOST FINISHED HIGH
SCHOOL, VERY FEW WITH COLLEGE
DEGREES, FAIR NUMBER OF PEOPLE
WHO DIDN'T HAVE A DIPLOMA OR
GED, PEOPLE BENEATHER EMPLOYEE
NOR SCHOOL NOR RAISING SMALL
CHILDREN, LOG OF MENTAL HEALTH
CONCERNS, 25% POPULATION
STREAMED POSITIVE FOR DEPRESSION
AND ANOTHER 35% -- SOME OVERLAP
BUT 35% SCREEN POSITIVE FOR
ANXIETY SO INCREDIBLY HIGH
LEVELS OF DEPRESSION AND ANXIETY
MUCH HIGHER THAN WHAT IS
REPRESENTED IN THE PREGNANT
POPULATION IN GENERAL.
THIS IS MEDICAID AND CHIP
POPULATION.
HIGH LEVELS OF FOOD EPISECURITY
AN HOUSING INSECURITY.
NEXT SLIDE PLEASE.
SO IN OUR CASE STUDY, WE HAD A
ROBUST CASE STUDY COMPONENTS WE
VISITED TALKED WITH SITES TWICE
IN PERSON AND TWICE VIRTUALLY,
COMPARED TO TYPICAL CARE MOST
CARE OFFERED MORE TIME WITH
CLINICAL PROVIDER OR WITH
ANCILLARY PROVIDER SUCH AS CARE
COORDINATOR.
MORE COMPREHENSIVE INTENSIVE
PATIENT EDUCATION CONTINUITY
RELATIONSHIP BUILDING, SOMETIMES
WITH THE PROVIDER SOMETIMES WITH
ANCILLARY PROVIDERS.
MORE INVOLVEMENT OF PARTNERS AND
FAMILY MEMBERS IN THE GROUP CARE
AND BIRTH CENTER MODEL, AND MORE
EFFORTS TO ADDRESS BARRIERS TO
CARE SUCH AS TRANSPORTATION TO
GET TO APPOINTMENTS.
NEXT LIED PLEASE.
SO I WILL SHOW YOU RESULTS FROM
THE START STOP EVALUATION.
ALL ARE RISK MATCH COMPARISON
GROUP SO NOT COMPARING MANY THE
BIRTH CENTER MODEL WHICH DID
HAVE AN OVERALL LOWER RISK
POPULATION TO THE KINDS OF
PEOPLE WHO WOULD HAVE ENROLLED
IN MATERNITY CARE MODEL.
ALL RISK MATCHED AGAINST OTHER
MEDICAID PARTICIPANTS IN THEIR
STATE WHO HAVE SIMILAR RISK
LEVELS CORK TO RECORDS AND
DIAGNOSTIC CLAIMS.
I HAVE RESULTS ABOUT EQUITY
ISSUE, THOSE ARE BASED ON
PROGRAM DATA LOOKING AT THE
THREE PROGRAMS RELATIVE TO EACH
OTHER.
FOR PEOPLE WHO ACTUALLY
ENROLLED.
BUT THE OUTCOMES DATA IS FROM
PROPENSITY SCORE WEIGHTED
COMPARISON GROUP.
NEXT SLIDE PLEASE.
SO JUST OVERALL RESULTS OF THE
MODEL WE FOUND IN BIRTH CENTERS
THE COSTS WERE FAR LOWER FOR THE
PARENT INFANT DYAD, $2,000 LOWER
PER DYAD.
FROM -- WE MEASURED FROM THE
BASICALLY THE EIGHT MONTHS
BEFORE PERSON HAD THEIR BIRTH UP
THROUGH ONE YEAR AFTER BIRTH.
THEY HAD LOWER UTILIZATION,
LOWER HOSPITAL VISITS, LOWER ED
VISITS, BETTER ESPECIALLY
INFANTS.
HIGHER QUALITY PRE-TERM BIRTH
RATES 25% LOWER AMONG THOSE
BIRTH CENTERS AND COMPARABLE
POPULATION.
LOW BIRTH WEIGHT RATES WERE 20%
LOWER AND CESAREAN RATES 40%,
AGAINST A RISK MATCHED
POPULATION AND HALF BIRTH CENTER
PARTICIPANTS GAVE BIRTH AT
HOSPITAL WHETHER BY CHOICE OR
NECESSITY.
FROM EQUITY PERSPECTIVE IMPROVED
OUTCOMES FOR RACIALETH I RACIAL ETHNIC
GROUPS.
THE EQUITY GAP BETWEEN WHITE AND
BLACK PARTICIPANTS DID -- WAS
SMALLER IN BIRTH CENTERS
RELATIVE TO POPULATION AS A
WHOLE.
BUT THAT AGAIN IS NOT AGAINST
THE WEIGHTED COMPARISON GROUP.
THAT IS LOOKING A PROGRAM DATA.
GROUP PRE-NATAL CARE WE FOUND
LOWER COST PARTICULARLY IN
PRE-NATAL PERIOD, SLIGHTLY LOWER
UTILIZATION, QUALITY WAS
MODESTLY HIGHER SLIGHT DECREASE
IN PRE-TERM BIRTH RATES INCREASE
VAGINAL BIRTH AFTER CESAREAN AN
IMPROVED OUTCOMES FOR WHITE AN
BLACK PARTICIPANTS IN GROUP
PRE-NATAL CARE RELATIVE TO MA
TERMTY CARE HOME MODEL.
HOMES HAD HIGHER COSTS ALMOST
$1,000 PER DYAD.
RESULTS ON UTILIZATION WERE
MIXED, NOT VERY STRONG RESULTS
EITHER WAY BUT SOME THINGS
HIGHER SOME LOWER.
QUALITY AGAIN MODESTLY LOWER
ALTHOUGH EFFECTS WERE NOT
PARTICULARLY ROBUST.
AND FROM EQUITY DIDN'T SEE ANY
IMPROVED OUTCOMES FOR ANY GROUP.
NEXT SLIDE PLEASE.
SO WHY DIDN'T -- STRONG START
NOT SEE MORE RESULTS?
SOME PANELIST IT IS LAST SESSION
GOT AT SOME OF THESE ISSUES
BECAUSE EVERYBODY WAS SCREENED
THOROUGHLY SO IT WAS
INSTRUMENTAL AND IDENTIFYING
NEEDS BUT THERE ARE INSUFFICIENT
RESOURCES IN MOST COMMUNITIES
FOR IDENTIFYING THOSE NEEDS.
SOME OF THE BIGGEST GAPS ARE IN
MENTAL HEALTH SERVICES, DOMESTIC
VIOLENCE REFERRALS
TRANSPORTATION AND ALSO FOR
GENERAL HEALTH SAFE AND WEATHER
APPROPRIATE EXERCISE OPTIONS.
SO WE SAW REAL DIFFICULTY
GETTING PEOPLE WITH VEER MENTAL
HEALTH ISSUES IN TO THE CARE
THAT THEY NEEDED.
THERE ARE NOT PSYCHIATRISTS AT
ALL WHO WILL ACCEPT MEDICAID
PARTICIPANTS.
WHEN THERE ARE THEY INFREQUENTLY
SPECIALIZE IN PREGNANCY SO
PEOPLE WITH SEVERE MENTAL HEALTH
CONDITIONS WOULD HAVE A HARD
TIME FINDING ANYBODY TO DO
MEDICATION MANAGEMENT DURING
PREGNANCY AND WAIT TO SEE HOW
MORE GENTLEMEN TALL HEALTH
PROVIDER LIKE SOCIAL WORKER
COULD TAKE MONTHS AND MONTHS.
WE SAW EVEN MEDICAID PROVIDES
TRANSPORTATION AND THAT IS A
REQUIRED BENEFIT OF MEDICAID, IT
CAN BE COMPLICATED TO SET UP,
PEOPLE OFTEN COULDN'T BRING
CHILDREN WITH THEM ON THE
TRANSPORT AND WHILE THEY SAID
PEOPLE WERE GENERALLY GOOD ABOUT
PICKING THEM UP AND GETTING THEM
TO APPOINTMENT, THEY WERE NOT SO
GREAT PICKING THEM UP FROM I A
POINTMENT TO HOME SO THEY WERE
RELUCTANT THE USE THE SERVICE
EVEN IF ABLE TO BOOK 48 HOURS IN
ADVANCE AND OTHER REQUIREMENTS
INVOLVED.
SO IN OUR CASE STUDY ANALYSIS WE
ALSO LOOKED AT WHAT HELPED TO
EXPLAIN SOME OF THE POSITIVE
RESULTS THAT WE SAW, PROVIDERS
SPEND MORE TIME WITH PATIENTS
PARTICULARLY THE PRIMARY
PRE-NATAL CARE PROVIDER SO NOT
JUST CARE COORDINATOR BUT THE
PERSON WHO WAS PROVIDING CARE.
SO IN THE MIDWIFERY MODEL AND
BIRTH CENTER MODEL WE SAW THE
PRIMARY PROVIDERS SPENDING
USUALLY 30 TO 60 MINUTES PER
APPOINTMENT, 30 FOR TYPICAL AND
HOUR OR SOMETIMES LONGER FOR
MORE EXTEND AID POINTMENT.
IN GROUP CARE THE TIME
INDIVIDUAL TIME APPOINTMENT IS
SHORT, A QUICK HEALTH CHECK BUT
THEY SPEND 90 MINUTES WITH THE
PROVIDER AFTERWARDS IN THE GROUP
WITH FACILITATED DISCUSSION.
BETTER CARE CONTINUITY, DIVERSE
CENTERS HAD SMALL STAFF SO EVEN
IF THEY WERE PERSONALLY SEEN
MORE THAN ONE MIDWIFE IT WAS A
COUPLE OF MIDWIFES, AGAIN WITH
LONG APPOINTMENTS THERE WAS TIME
FOR RELATIONSHIP BUILDING EVEN
IF THEY WERE SEEING MULTIPLE
PEOPLE.
AND WITH GROUP PRE-NATAL CARE IT
WAS THE SAME PROVIDERS WHO WERE
LEADING ALL THE SESSIONS.
THERE WAS FOCUS ON
INDIVIDUALIZED HEALTH EDUCATION
FOR PEOPLE AGAIN ESPECIALLY
NOTED IN THE BIRTH CENTER AND
CENTER PREGNANCY MODELS AND MORE
EXTENSIVE PSYCHOSOCIAL SUPPORT,
CARE COORDINATORS PROVIDED THAT
IN THE MA ATTORNEY UNTIL CARE
HOME HOMEDS AS WELL AS WHAT WE
SAW FROM PROVIDERS AND ANCILLARY
SUPPORT IN OTHER TWO MODELS.
LACK OF COMMUNITY RESOURCES,
REAL PROBLEM, LOTS OF VARIATION
IN SERVICES THOUGH WE DID NOT
FIND THAT SERVICE INTENSITY.
CORRELATED AT ALL WITH OUTCOMES.
IN OUR MATERNITY CARE HOME
MODELS MORE CARE COORDINATION
VISITS, MORE CONTACT WITH
PROVIDERS SO FORTH WE DID NOT
SEE ANY DIFFERENCES IN THE
OUTCOMES AMONG THOSE MODELS.
RISK FACTORS MAY NOT HAVE BEEN
ACCOUNTED FOR IN THE DATA
SOURCES WE TRIED TO DO A JOB OF
CONTROLLING, WE HAD INFORMATION
FROM VITAL RECORDS AND WHEN WE
ADDED CONTROLS FROM MEDICAID
DIAGNOSTIC CLAIM, FOR INSTANCE
SOMETHING IDENTIFIED SOMEONE WHO
HAD A HIGH RISK REFERRAL FOR
SEVERE HYPERTENSION, THINGS
ALONG THOSE LINES, THEY DIDN'T
HAVE MUCH EFFECT ON WHAT WE SAW
RESULTS WISE.
SO WITH THE BIRTH CENTERS I KNOW
THERE HAD STATISTICIAN IT WAS
WORKING ON THIS, CONVINCED SOON
AS WE PUT IN DIEG NOS ACTION I
CODES WE SEE THOSE POSITIVE
EFFECTS DISAPPEAR AND INSTEAD
REMAINED WILDCAL.
THE CORE COMMUNICATION AMONG
PROVIDERS SOMETIMES IN SAME
CLINIC BUT WHEN PEOPLE WERE
GETTING CARE FROM MULTIPLE
SOURCES SO BEHAVIORAL HEALTH
PROVIDERS NOT COMMUNICATING WITH
THE PRE-NATAL CARE PROUD
VIEWERS, NOT PRIMARY HEALTH
PROVIDERS SPECIALISTS IN THE
INFORMATION PEOPLE GOT FROM THE
PATIENT HERSELF AND NOT FROM
ACTUALLY COORDINATING ANY HEALTH
RECORDS OR TALKING TO ANY OTHER
PROVIDER.
CORE COMMUNICATION BETWEEN CARE
COORDINATION AND CLINICAL
PROVIDERS SO THOUGH THEY WERE
USUALLY IN THE SAME
INSTITUTIONS, THEY DIDN'T TALK
TO EACH OTHER MUCH, THE CLINICAL
PROVIDERS TENDED TO REALLY WANT
THE CARE COORDINATORS TO TAKE ON
BURDENS TO LIGHTEN LOADS, WE
KNOW THAT THERE IS A LOT OF
PRESSURE ON PROVIDERS, NOT LOT
OF TIME FOR APPOINTMENTS AND
THAT ARE REIMBURSEMENT SYSTEM
TENDS TO REWARD DOING PROCEDURES
RATHER THAN SPENDING TIME WITH
PEOPLE.
WE IN ONE OF OUR CLINICS CARE
COORDINATORS BAKING BROWNIES FOR
THE OBSTETRICIANS TO TRY TO TALK
TO THEM, THEY DIDN'T NECESSARILY
HAVE ACCESS TO THE ELECTRONIC
HEALTH RECORD SO THEY COULDN'T
SEE WHAT IS GOING ON WITH
PATIENTS AND ENTER NOTES ABOUT
THE PATIENTS.
AND EVEN WHEN THEY WERE ABLE TO
DO THAT, THEY TEND -- REPORTED
THAT OFTEN THE PROVIDERS WEREN'T
NEEDING THEM.
AND THEY DON'T NECESSARILY EACH
OTHER'S NOTES SO BECOMES REALLY
DIFFERENT PROVIDER EVERY VISIT
BECAUSE SHE OFTEN HAVING TO TELL
STORY EVERY TIME AND I GET
CONFLICTING ADVICE FROM
DIFFERENT PROVIDERS BECAUSE THEY
ARE SOMETIMES MORE THAN ONE
EVIDENCE BASE WADE OF ADDRESSING
A PROBLEM.
POOR COMMUNICATION BETWEEN
CLINICAL AND SOCIAL SERVICE
PROVIDERS, WE RARELY KNEW
WHETHER OR NOT RESULTS IN ANY
FOLLOW-UP.
NEXT SLIDE PLEASE.
SO WHAT LESSONS DID WE THEN
LEARN FOR MOVING THE NEEDLE ON
PRE-TERM BIRTH?
HOLISTIC TIME INTENSIVE CARE ON
HEALTH EDUCATION PSYCHOSOCIAL
SUPPORT WHICH SEEM EXEMPLIFIED
IN THE MIDWIFERY MODEL CAN BE
PRACTICED BY ANY PROVIDER AND
SETTING LIKE MIDWIVES PRACTICE
ACCORDING TO MEDICAL MODEL AND
OFTEN DO IN CLINICAL SETTINGS.
ANY PROVIDER PRACTICE ACCORDING
TO MIDWIFERY MODEL.
CONTINUITY BUILDS RELATIONSHIPS
IN CENTRALIZES INFORMATION.
ADDRESSING PHYSICAL MENTAL
SOCIAL HEALTH IS NECESSARY FOR
IMPROVING OUTCOMES.
EVIDENCE BASED PRE-NATAL CARE
NEEDS COMPLIMENTARY SYSTEMS
MEDICALLY -- MEDICALLY AND
BEHAVIORALLY AND IN THE
COMMUNITY SUPPORT IN A SYSTEM
THAT IS INTEGRATED.
WE ARE NOT PUTTING
RESPONSIBILITY ON PATIENT TO GO
TO 20 PLACES TO GET THINGS SHE
NEEDS OR SEEING ONE COMMUNITY
HEALTH WORKER BEING PAID $15 AN
HOUR IS GOING TO SOLVE THE
WORD'S PROBLEMS, VERY LARGE
ROBUST CLINICAL SYSTEM HASN'T
BEEN ABLE TO SOLVE ON ITS OWN.
IN COORDINATION TO KNOW WHERE IS
A LOSING GAME FOR EVERYONE SO
WHEN YOU IDENTIFY A PERSON HAS
INTENSE NEEDS BUT YOU CAN'T
OFFER HER ANYTHING THAT IS GOING
TO PROVIDE HELP WHERE SHE WILL
HAVE TO WAIT, SIX MONTHS OR IN
THE CASE OF HOUSING, SOMETIMES
FOR YEARS AND YEARS YOU ARE NOT
GOING TO SEE ANY IMMEDIATE
IMPACT ON BIRTH OUTCOMES BECAUSE
SHE HASN'T GOTTEN ASSISTANCE.
NEXT SLIDE PLEASE.
CARE COORDINATORS AND COMMUNITY
HEALTH WORKERS CAN BE VALUABLE
MEMBERS OF CARE TEAMS CERTAINLY
PARTICIPANTS APPRECIATED THE
EFFORTS THEY PUT IN.
OFTEN THEY SAY BECAUSE OF THIS
PERSON I GOT A CAR SEAT THAT WAS
GREAT BUT GETTING A CAR SEAT
ISN'T GOING TO PREVENT YOU FROM
HAVING PRE-TERM BIRTH.
THEY CAN'T SOLVE PERSONAL
SYSTEMIC PROBLEMS ALONE.
NEXT SLIDE.
>> ONE BIG THING WE LEARNED FROM
STRONG START WAS IMPORTANCE OF
INTEGRATION OVER COORDINATION.
NEXT SLIDE.
SO THE CONCEPT OF CARE
INTEGRATION IS THAT YOU ARE
CREATING TEAMS OF HEALTHCARE
SOCIAL SERVICES AND PAYER GROUPS
OFTEN THROUGH CO-LOCATED CARE
AND DATA SHARING WHICH IS
CRITICAL TO DELIVER EVIDENCE
BASED TREATMENT THAT MEETS
PATIENT NEEDS.
NEXT SLIDE.
SO WE HEARD STRONGLY WE DID A
LOT OF INTERVIEWS WITH SUBJECT
MATTER EXPERTS AND DID ACTUALLY
FOR PUBLIC REQUEST FOR
INFORMATION AND WHERE PEOPLE
IDENTIFY DATA SHARING AS ONE OF
THE MOST CRITICAL COMPONENTS OF
MOVING THE NEEDLE SO MATERNAL
OPIOID MISUSE MACK SURE WE HAVE
REQUIREMENTS IN PLACE THAT
MATERNITY AND INFANT CARE
BEHAVIORAL CARE AND PRIMARY CARE
OPIOID USE DISORDERS TREATMENT
BUZZ THE MODEL IS FOCUSED ON
PREGNANT AND POSTPARTUM PEOPLE
WITH OPIOID USE DISORDER WOULD
BE INTEGRATED WHERE EVERYBODY
CAN SEE EVERYBODY ELSE DATA AND
KNOW WHAT WAS GOING ON.
AND THERE WOULD BE WRAP AROUND
SERVICES WITH CARE COORDINATION
ENGAGEMENT REFERRALS WITH
ATTEMPT TO INTEGRATE THOUGHT
DATA SYSTEMS TO THE EXTENT
POSSIBLE AS WELL.
DATA SHARING WAS OPERATED BY
CARERY PARTNERS WITH SUPPORT
FROM STATE MEDICAID AGENCY AND
AWARDS MADE WERE MADE DIRECTLY
TO STATE MEDICAID AGENCIES.
YOU CAN GET MORE INFORMATION
ABOUT THE MODEL, CARE I HAVE THE
WEB SITES DOWN FOR ALL THE
MODELS AND THE SLIDES BUT THEY
ARE AVAILABLE ON THE INNOVATION
CENTER WEBSITE.
WE JUST -- WE WILL BE PUBLISHING
THE FIRST REPORT FROM THE
MATERNAL OPIOID MISUSE MODEL,
PROBABLY IN FEBRUARY. BUT I
WILL SAY ONE INTERESTING THING
WAS WE HEARD STRONGLY FROM THE
PROVIDERS WITHIN THE MODEL,
ITSELF, HOW IMPORTANT THIS DATA
SHARING WAS.
YET THAT WAS ALSO THE THING
WHICH WE GOT RESISTANCE SO
PEOPLE SAY WE HAVE TO SHARE
DATA, WE DON'T KNOW WHAT IS
GOING ON WITH PATIENTS WE CAN'T
SERVE PROPERLY WITHOUT BETTER
COMMUNICATION.
THEN SAY HOW DO YOU EXPECT US TO
ORGANIZE THESE DATA SHARING
SYSTEMS, WE CAN'T DO THAT.
HOW WOULD THE -- KNOW WHAT
BEHAVIORAL HEALTH PROVIDER IS
DOING?
THERE WAS A REAL DISCONNECT I
THINK BETWEEN WHAT PEOPLE KNOW
THEY NEED.
AND AMOUNT OF EFFORT THAT IT
TAKES TO ACTUALLY PUT THAT INTO
PLACE.
IT IS HARD, IT IS REALLY HARD.
THIS IS ONE OF THE REASONS
RELYING ON CARE COORDINATORS YOU
CAN HIRE A CARE COORDINATOR FOR
NOT MUCH MONEY IN THE GREATER
SCHEME OF THINGS.
AND FEEL LIKE YOU ARE DOING
SOMETHING.
YET THAT'S NOT FROM EVIDENCE WE
HAVE SEEN NOT ONLY HERE BUT IN A
LOT OF PLACES INCLUDING IN SOME
OF THE WHAT OUR OTHER PANEL U.S.
TOLD US WE DON'T SEE HAVING CARE
COORDINATOR ALONE WILL BE ABLE
TO IMPLEMENT MUCH CHANGE.
NEXT SLIDE PLEASE.
SO THE OTHER MODEL THAT WE ARE
CURRENTLY WORKING ON WHERE WE
HAVE LEARNED LESSONS FROM STRONG
START FROM OTHERS NEWBORN
INITIATIVE IS INTEGRATED CARE
INITIATIVE, THIS IS A BIGGER
LIFT THAN MOM THAT WE ARE
INTEGRATING CLINICAL CARE,
SCHOOLS HOUSING FOOD NUTRITION,
EARLY CARE AND EDUCATION.
TITLE 5 AGENCIES CHILD WELFARE
AND MOBILE CRISIS RESPONSE
SERVICES.
WE GAVE OUR AWARDEES TWO YEARS
TO RAMP UP THESE PROGRAMS,
HOPING THAT THAT WOULD GIVE
ENOUGH TIME TO GET SYSTEMS
BETTER COORDINATED.
IT HAS BEEN A REAL CHALLENGE.
THERE ARE A LOT OF PRIVACY
REGULATIONS AROUND SHARING DATA,
SYSTEMS DON'T NECESSARILY TALK
TO EACH OTHER.
WE HAVE HAD A LOT OF AWARDEES
WHO MANAGED TO DO THINGS IN INK
WITH EHR TO GET SCREENINGS PUT
IN THERE AND BE ABLE TO SHARE
WITH PROVIDERS AND NETWORK,
THERE ARE HEALTH INFORMATION
EXCHANGES IN MANY STATES AND
OTHER PLATFORMS THAT STATES HAVE
BEEN TRYING TO USE TO GET DATA
SHARING HAPPENING IN THESE
MODELS.
THERE HAVE BEEN MORE
REQUIREMENTS FOR THE PEOPLE
PARTICIPATING TO ACTUALLY USE
THOSE PLATFORMS.
BUT IT IS STILL A WORK IN
PROGRESS AND THE FACT THAT THERE
AREN'T NECESSARILY ADEQUATE
RESOURCES IN THE COMMUNITY IS
NOT SOMETHING THAT MEDICAID
PROGRAM ON ITS OWN CAN SOLVE.
SO THERE ARE MORE SLIDES IN
HERE, WHICH I'M NOT GOING TO --
I PUT THEM IN FOR REFERENCE
PURPOSES IF ANYBODY WANTED MORE
DETAIL, WE ALSO AGAIN ON OUR
WEBSITE AT THE INNOVATION CENTER
HAVE A LOT OF INFORMATION ABOUT
ALL THESE MODELS INCLUDING ALL
THE EVALUATION REPORTS FROM
STRONG START AND AT A GLANCE
DOCUMENT THAT GIVES A NICE I
DON'T HAVE VIEW, SOMETHING LIKE
THAT WILL BE POSTED FOR MOM IN
FEBRUARY, THE FIRST ANNUAL
REPORT FOR INK WHICH WILL COVER
PRE-IMPLEMENTATION PERIOD WILL
BE OUT IN 2022 BUT PROBABLY NOT
UNTIL END OF THE YEAR.
SO THANK YOU VERY MUCH.
>> THANK YOU DR. CROSS BARNET
FOR THAT OUTSTANDING
PRESENTATION.
NEXT WE WILL HEAR FROM MS. RYAN
ARGENTIERI AND JAWANNA HENRY.
>> GOOD AFTERNOON, EVERYONE.
CAN YOU HEAR ME OKAY?
>> YES.
>> OKAY.
GREAT.
THANK YOU SO MUCH FOR HAVING US,
MY NAME IS RYAN ARGENTIERI,
DEPUTY DIRECTOR OF THE OFFICE OF
TECHNOLOGY AT ONC OFFICE
NATIONAL COORDINATOR FOR OIT
PART OF THE HEALTH AND HUMAN
SERVICES DEPARTMENT MOST OF YOU
KNOW THAT.
AND I'M JOINED BY JAWANNA HENRY
ONE OF OUR CHIEF ANALYSTS IN
OFFICE OF TECHNOLOGY AND JAWANNA
IS LEAD FOR OUR SOCIAL
DETERMINANTS OF HEALTH PORTFOLIO
AMONG OTHER WORK STREAMS HER
EXPERTISE WILL COME THROUGH AS
SHE GETS INTO THE PRESENTATION.
WE ARE GOING TO TALK TO YOU
ABOUT COORDINATED REGISTRY
NETWORK FOR WOMEN'S HEALTH.
>> WHY DON'T I DO DISPLAY
SETTINGS CO-OPT PLEASE.
PERFECT.
>> GREAT, THANKS.
WE WILL TALK TO YOU AND GIVE YOU
A BIT OF INFORMATION THREE
MINUTES OR LESS OMC AND WORK WE
DO TO SUPPORT IMPROVED
HEALTHCARE FOR WOMEN ACROSS THE
CONTINUUM AND JUST THE FOCUS
THAT ONC HAS BECAUSE WE REALIZE
MORE AND MORE THAT WHILE YOU
MIGHT BE BEENING FROM WORK FROM
A PATIENT PERSPECTIVE BECAUSE OF
THE WORK WE DO FOR PATIENT
ACCESS AND ELECTRONIC HEALTH
INFORMATION YOU MIGHT NOT BE
AWARE OF WHAT ONC IS AND HOW WE
MIGHT BE ABLE TO WORK CLOSELY
WITH YOU AND YOUR VARIOUS
ORGANIZATIONS.
SO NEXT SLIDE JAWANNA.
SO THIS IS A LITTLE BIT ABOUT
ONC AND WORK WE DO TO ESTABLISH
EXPECTATIONS AND STANDARDS FOR
DATA EXCHANGE AND CERTIFICATION.
WE DO THIS BY COORDINATING WITH
OUR FEDERAL PARTNERS BOTH WITHIN
HHS BUT INCREASINGLY OUTSIDE OF
HHS.
AS WELL AS STATE AND LOCAL
HEALTH OFFICIALS AND DOWNSTREAM
USERS AND DEVELOPERS OF HEALTH I
T.
SO WE ARE COMMITTED TO MAKING
SURE THAT OUR WORK AND
DEVELOPING ADVANCING STANDARDS
AN CERTIFICATION EXCHANGE DOES
HAVE THE BENEFIT FOR IMPROVING
PATIENT HEALTH FOR PEOPLE ACROSS
THE COUNTRY NO MATTER WHO THEY
ARE AND WHERE THEY COME FROM.
NEXT SLIDE.
SO WOMEN IN HEALTHCARE ARE
CONCERNED, WE ARE VERY FORTUNATE
TO BE IN AN ENVIRONMENT NOW WITH
NATIONAL COORDINATOR NOT THAT WE
HAVEN'T HAD IN PREVIOUS
ADMINISTRATION BUT NATIONAL
COORDINATOR DR. ARGENTIERI IS
FOCUSED BY DESIGN AND MAKING
SURE WE PRIORITIZE NEEDS OF
COMMUNITIES INCLUDING THOSE
PEOPLE AND POPULATIONS WHO ARE
NOT GETTING THE CARE THEY NEED
OR WHERE THERE ARE OPPORTUNITIES
TO IMPROVE CARE.
AND FOR WOMEN THAT MEANS ARMING
US SINCE I AM A WOMAN WITH
NECESSARY HEALTHCARE INFORMATION
THROUGH KEY TOUCH POINTS IN
THEIR LIVES.
WHETHER YOU BE SOMEONE WITH
CHILDREN OR GOING THROUGH THE
MATERNAL PROCESS, OR CAREGIVER
INCREASINGLY WE ARE SEEING MORE
AND MORE FOR YOURSELF YOUR
CHILDREN BUT EXTENDED FAMILY AND
FRIDAY, WE HELP TO MAKE SURE
WOMEN HAVE WHAT THEY NEED TO
SUPPORT SUCCESSFUL HEALTH
OUTCOMES, THROUGHOUT THE COURSE
OF THEIR LIVES.
NEXT SLIDE.
SO H IS A LITTLE INFORMATION
ABOUT OUR STANDARDS DEVELOPMENT
ACTIVITY AND HOW WE VIEW
ESPECIALLY WHERE WE ARE TALKING
SPECIAL INITIATIVES FOR EXAMPLE
WOMEN IN HEALTHCARE, WE START
WITH THIS STANDARDS AND DATA AS
FOUNDATION IN MIND THEN HOW THAT
DATA TRANSLATES TO POLICY
DECISIONS IMPLEMENTATION WITH
MARKET AND INDUSTRY STAKE
HOLDERS AND ULTIMATELY HOW THOSE
DECISIONS AND PIECES OF THAT
PUZZLE BUILD STRONGER
INFRASTRUCTURE AND WHERE HEALTH
INFORMATION IS CONCERNED MEANS
INTEROPERABILITY AND
INTEROPERABILITY WITH MINIMUM
BURDEN FOR ESPECIALLY PROVIDERS
BUT FOR ALL THROUGHOUT THE
PIPELINE THROUGH WHICH THAT
INFORMATION IS EXCHANGED.
MENTION SLIDE.
SOME OF THIS WILL BE WE CAN MAKE
AVAILABLE BUT THESE ARE SOME OF
THE AREAS OF PRIORITY AND SOME
OF THE RESOURCES THAT ONC MAKES
AVAILABLE IF YOU AREN'T AWARE OF
THESE THEN WE WOULD INVITE YOU
TO COME OVER TO OUR WEBSITE AND
SEE HOW THEY SUPPORT AND ADVANCE
YOUR WORK INCLUDING AUDIENCE
MEMBERS AND OTHER PANELISTS.
WITH THAT, I THINK I'M GOING TO
PASS TO JAWANNA TO TALK TO
GREATER DETAIL ABOUT OUR
PROGRAMS THAT WE ARE EXCITED
ABOUT PRODUCT THAT HELPS TO
SUPPORT WOMEN HEALTH ISSUES.
JAWANNA.
>> THANK YOU, RYAN FOR DOING
THAT INTRODUCTION AN OVERVIEW OF
ONC AS RYAN MENTIONED I AM GOING
TO NOW TAKE THE REST OF THE TIME
TO TALK ABOUT A SPECIFIC PROJECT
RELATED TO WOMEN'S HEALTH AND
THAT'S THE PATIENT CENTERED
OUTCOMES RESEARCH OR PCOR TRUST
FUNDED WOMEN'S HEALTH TECHNOLOGY
COORDINATED REGISTRY NETWORK.
NOW WHEN WE TALK PCOR WE ARE
TALKING A PROJECT FUNDED THROUGH
THIS TRUST FUND AND THROUGH ASP
AS INTERDEPARTMENTAL PROJECT TO
BUILD P 4 CAPACITY, PCOR
PRODUCES NEW SCIENTIFIC EVIDENCE
TO INFORM AND SUPPORT HEALTHCARE
DECISIONS AND PATIENT FAMILIES
AS WELL AS HEALTHCARE PROVIDERS.
SO AS I MENTION THIS IS AN
INTRADEPARTMENTAL PROJECT YOU
CAN SEE ALL OUR PARTNERS LISTED
HERE.
AND OUR ADMINISTRATION WAS LEAD
FOR THIS PROJECT.
NOW I WILL GO INTO DETAILS.
OF THE PROJECT.
WHEN WE ARE TALKING REGISTRIES
ON WHAT THEY DO, REGISTRIES
PROVIDE KEY INFRASTRUCTURE THAT
CAN BE USED FOR POLYIMPROVEMENT
AND EVALUATION OF PATIENT CARE
AND OUTCOMES MOST OF THE
REGISTRIES TO DATE ARE USED FOR
SINGLE PURPOSE, AND CAN BE TIME
AND COST INTENSIVE TO MAINTAIN.
BUT TRANSFORMED FOR ANALYSIS AND
RESEARCH PURPOSES.
BUT ONE OF THE ISSUE IS BECAUSE
SINGLE USE PURCHASE REGISTRY
LIMIT STUDY DESIGNS TO ONE
PARTICULAR THERAPY WHETHER IT BE
MEDICATION OR DEVICE INSTEAD OF
BEING ABLE TO PRODUCE DESIGN TO
LOOK AT COMBINATION OF THERAPIES
THAT INCLUDE MORE.
SO OUR VISION FOR THE WHTCRN WAS
TO LOOK AT THESE DATA SOURCES
AND LOOK FOR OPPORTUNITIES FOR
INTEROPERABILITY AND
HARMONIZATION AND THE ABILITY TO
USE PREVIOUS WORK SUCH AS
STRUCTURED DATA CAPTURE WHICH IS
A RESOURCE THAT WAS DEVELOPED
THROUGH OUR OFFICE TO B BE ABLE
TO RECEIVE DATA.
DISPLAY THAT DATA AS WELL AS
STORE THAT DATA FOR REGISTRIES
SO NOT JUST DATA PORTION BUT
OPPORTUNITY FOR ALL OUR
STAKEHOLDERS, LOOKING AT
HEALTHCARE PROVIDERS, PATIENT
AGENTS, RESEARCHERS HEALTH
SYSTEM Z AS WELL AS EHR VENDORS.
WE LOOK AT GOALS FOR CRN PROJECT
THIS OVERALL WAS SOMETHING THAT
WAS COORDINATED HARMONIZED
EFFICIENT AS WELL AS TARGETED.
L SO WHEN WE TALK ABOUT
COORDINATED WHAT WE ARE LOOKING
AT OR FOR IS A COMPREHENSIVE
APPROACH TO IMPROVING EVALUATION
IN THEM HEALTH TECHNOLOGIES
ACROSS CARE SETTINGS.
THAT HARMONIZING PIECE WANT TO
MAKE SURE THAT AS THIS RESCUE
NETWORK DEVELOPED IT WAS
INTEROPERABLE PLATFORM TO LINK
REGISTRIES TO ETCH OOH OTHER AS
WELL AS OTHER DATA NETWORKS.
MAKE SURE TOOLS FOR COLLECTING
THAT DATA IN THE REGISTRIES AND
BEING ABLE TO EXTRACT IT AND
LINK IT WHERE EFFICIENT AND USE
DIFFERENT SOURCES OF DATA SUCH
AS CLAIMS AND INFORMATION FROM
EHR THAT FLOWS TO THAT REGISTRY
NETWORK AND LASTLY MAKE SURE
THERE WAS A TARGETED APPROACH SO
BEING ABLE TO ADDRESS
PERFORMANCE OF DEVICES AND
THERAPIES FOR TREATMENT
SPECIFICALLY FOR PELVIC FLOOR
DISORDERS AND FEMALE
STERILIZATION.
AS I WILL MENTION WHCCRN PROJECT
WAS INTERDEPARTMENTAL PROJECT
INCLUDE VARIOUS FEDERAL
AGENCIES.
WE LOOK AT THE RESPONSIBILITY OF
ONC OUR SCOPE WAS TO MAKE SURE
THAT WE DEVELOPED IMPLEMENTED
AND REFINED WOMEN HEALTH
TECHNOLOGY COORDINATED NETWORK
IMPLEMENTATION GUIDE AND ONCE
THAT GUIDE WANTED TO BE ABLE TO
USE IN A TEST ENVIRONMENT AS
WELL AS PRODUCTION ENVIRONMENT
SO USED AMONG CLINICALS AND
DIFFERENT PROVIDER SETTINGS AND
USE IN MANUFACTURING SETTING.
SO OUR PURPOSE WAS TO LOOK AT
THE DIFFERENT CRN CAPABILITIES
NOT TWO SPECIFIC ACTORS IN
INTERACTIONS AND THE TECHNICAL
SPECIFICATIONS FOR THE CRN
IMPLEMENTATION GUIDE AND TEST
THOSE OUT.
AGAIN IN THOSE DIFFERENT
ENVIRONMENTS THAT I MENTIONED IN
THIS SCOPE.
SO OUR APPROACH FOR THE PROJECT
OVERALL AGAIN WAS TO DEVELOP A
FRAMEWORK THAT WAS STRUCTURED
FOR DATA SHARING
INTEROPERABILITY AMONK AMONG THE
DIFFERENCE DATA SOURCES, WE WANT
TO MAKE SURE WE DID PEAK WORK SO
LOOKING AT THE OPPORTUNITY TO
REUSE EXISTING STANDARDS AND
RESOURCES TO BE ABLE TO LINK
DIFFERENT PATIENT DATA
INDIVIDUAL DATA ACROSS DISPARATE
DATA SYSTEMS SO YOU CAN SEE THE
RESOURCES PREVIOUSLY USED SUCH
AS US CORE, THE STRUCTURE DATA
CAPTURE, WE ALSO HAVE RESOURCE
FOR PATIENT REPORTED OUTCOMES
AND DATA ACCESS FRAMEWORK
SPECIFIC FOR RESEARCH.
OUR TASK WAS TO TEST CAPTURING
EXCHANGE OF DATA TO SUPPORT
WOMEN HEALTH TECHNOLOGY ISSUE
AND WE DID THIS BY INCORPORATING
SOME PRELIMINARY DATA ELEMENTS
INTO WHAT WE CALL HL 7 WHICH IS
HEALTH LEVEL 7 FAST HEALTHCARE
INTEROPERABILITY RESOURCES OR
FIRE RESOURCES PROFILES SO YOU
SEE HERE SOME OF THOSE SPECIFIC
DATA ELEMENTS INCORPORATED INTO
HL 7 FIRE RESOURCES SUCH AS THE
PATIENT CHARACTERISTICS,
TREATMENT DETAILS AND ONE THING
THAT WAS SPECIFIC FOR THIS
PROJECT IS LOOKING AT THE UNIQUE
DEVICE IDENTIFIER SPECIFICALLY
FOR IMPLANTABLE DEVICES.
THEN WE ARE ALSO TASKED WITH
MAKING SURE WE EVALUATE THE
COMPLETENESS OF THE HL 7
RESOURCES SO THEY WOULD DO -- WE
WOULD KNOW THAT THEY DID WHAT
THEY WERE SUPPOSED TO.
WHAT YOU SEE HERE IS THE MODEL
THAT WAS SET UP FOR BEING ABLE
TO COLLECT DATA YOU CAN SEE HERE
THE YELLOW REPRESENTS DATA
SOURCES THAT ARE EXTERNAL TO THE
WOMEN'S HEALTH TECHNOLOGY
PROJECT AND IN BLUE YOU SEE
THOSE THAT ARE SPECIFIC TO
COORDINATED REGISTRY NETWORK
DATA COLLECTION.
IN THIS MODEL YOU HAVE THOSE
DIFFERENT SYSTEMS AND AGAIN OUR
GOAL WAS TO MAKE SURE THERE WAS
SPECIFIC CAPABILITIES THAT
FRAMEWORK WOULD DO.
SO THAT FIRST ONE YOU CAN SEE
HERE, TO CREATE PUBLISH CRN
INSTRUMENT THAT WOULD GO INTO
THAT CRN INSTRUMENT AND DATA
REPOSITORY.
THE SECOND IS WATCH A SMART CRN
APP FROM EHR AND ONCE LAUNCHED
WE WANTED TO MAKE SURE THE
INFORMATION COULD BE RETRIEVING
AND RENDERED FROM AGAIN THAT
METADATA REPOSITORY.
THEN FEEDBACK INTO THE EXTERNAL
DATA SYSTEM, SO HERE, WHEN WE
GET TO FOUR YOU CAN SEE THERE IS
THIS OPPORTUNITY FOR COLLECTING
DIFFERENT TYPES OF DATA FROM
DIFFERENT RESOURCES, SO GETTING
IT FROM THE CRN, GETTING DATA
THAT WAS PRE-POPULATEEPOPULATEED FROM THE
EHR BUT GETTING DATA SPECIFIC TO
THE UDI UNIQUE DEVICE IDENTIFIER
FROM THE GLOBAL UNIQUE DEVICE
IDENTIFIER DATABASE AS WELL AS
TERMINOLOGY API TO FEED DATA
SOURCE WITH HOPES OF BEING ABLE
TO THEN SUBMIT ALL THAT DATA
BACK TO THE SELF-REGISTRY.
NOW THAT I PROVIDED YOU WITH AN
OVERVIEW OF THE COLLECTION OF
THAT DATA, YOU MAY WONDER WHAT
THAT LOOKS LIKE FROM SIDE OF
RESEARCHER SO YOU HAVE A
RESEARCHER WHO DEVELOPED A
PROJECT PROPOSAL RESEARCH
QUESTIONS TO ANSWER SO THEY COME
POSE A NET QUERY FOR A SPECIFIC
RESEARCH DATA THROUGH THE
RESEARCH PORTAL.
THAT IS THEN DISTRIBUTED TO THE
DATA PARTNER CLIENT THAT FEEDS
INTO QUERY FOR THE WOMEN HEALTH
REGISTRY THAT DATA IS COLLECTED,
AND SUBMITTED BACK TO THE CLIENT
AND BACK THROUGH RESEARCH PORTAL
AND BACK THROUGH THE RESEARCHER.
SOME OF THESE STOPS ARE MORE
ABOUT CHECKING SECURITY OF THE
DATA.
SO THIS TABLE IS JUST REALLY THE
TAKE ALL THAT IN SO THAT YOU CAN
SEE IT UP FRONT.
AS I MENTIONED THERE WAS SEVERAL
CAPABILITIES AND THIS BREAKS IT
DOWN TO YOUR THREE DIFFERENT
ACTORS THAT ARE SPECIFIC TO CRN
PROJECT.
THOSE CAPABILITIES WERE THEY HAD
BUILT ON TOP OF EACH OTHER.
AGAIN YOU HAVE THAT REPOSITORY
PUBLISH THE CRN INSTRUMENT
EXTERNAL DATA COLLECTION SYSTEM
WE WANTED TO BE ABLE TO RELEAVE
AND RENDER CRN INSTRUMENT AND
COLLECT DATA AS WELL AS
TRANSFORM THAT DATA INTO
RESOURCES SO EACH CAPABILITY IS
BUILDING ON THE OTHER.
FINALLY FOR OUR WOMEN HEALTH
REGISTRY MAKING SURE THAT WAS
THE ABILITY TO RECEIVE CRN
INSTRUMENT COLLECT THE DATA AS
WELL AS OTHER FIRE RESOURCES.
OUR PILOT TEAMS WE HAD TWO PILOT
SITES AND THE FIRST ONE WAS THE
AMERICAN GAIN LO DODGIC SOCIETY
KNOWN AS AUX, WOMEN HEALTH
REGISTRY, THEY WERE IMPORTANT
PILOT SITES BECAUSE THEY SERVE
AS A SITE THAT HAD HAIR OWN
REGISTRY AND THAT IS WE DID OUR
FIRST FEEDS PIE WILL THE TESTING
AND THE SECOND PHASE IT WAS A
FULL PROJECT TEAM MULTIPLE STAGE
HOLDERS SO THEY HAD
REPRESENTATIVES OF SUPPORT FOR
THE HIGH PERFORMANCE INTEGRATED
VIRTUAL ENVIRONMENT ALSO KNOWN
AS HIGH, DATA AGGREGATION
ANALYTICS PLATFORM, WE HAD THE
SOCIETY OF NEURODYNAMICS PELVIC
FED MINUTE IN UROGENITAL
RECONSTRUCTION.
ALSO KNOWN AS -- A FOUNDATION
DEDICATED TO IMPROVING THE
SCIENCE OF YOUROLOGY, AND THEN
THEY HAD AS A PART OF THE TEAM
NEW YORK PRESBYTERIAN HOSPITAL Z
AND THE POINT HERE IS TO TAKE A
LOOK AT THESE DIFFERENT PILOT
SITES AND LOOKING AT STRUCTURE
AND BEING ABLE TO SEE THAT THE
STRUCTURE OF THESE PILOT SITES
CAN LOOK DIFFERENT IN TRYING TO
DEVELOP COORDINATED REGISTRY
NETWORK.
AND USE OF THE REGISTRY.
MAIN ACTIVITIES INCLUDED
STANDING UP FIRE SERVERS ON
AMAZON WEB SERVICES AND THAT WAS
FOR BOTH AUX AS WELL AS HIDE
PLATFORM AGAIN WE WERE TASKED
WITH DEVELOPING TESTING, APPS
AND MAKING SURE THEY WERE
AVAILABLE ON MOBILE AND
CONNECTED DEVICES THROUGH FIRE
AND MACK SURE THEY SUPPORTED
PELVIC ORGANIZATION ORGAN
PROLAPSE KNOWN AS POP
INCONTINENCE AS WELL AS LONG
ACTING REVERSIBLE CONTRACEPTIVE
KNOWN AS ARC.
DURING THIS PROJECT WE HAD TO
WORK WITH A CLINICAL TEAM TO
HELP WITH DETERMINING REFINING
FINALIZING THE DATA ELEMENTS FOR
TERMINOLOGY AND PREPARATION FOR
STORING INSTRUMENT DATA
INSTRUMENT REPOSITORY.
WE WANTED TO MAKE SURE AS APP
WAS DEVELOPED THAT WE JUST
DIDN'T DEVELOP AN APP AND PUT IT
OUT THERE WITHOUT TESTING.
WE WANTED CLINICIAN FEEDBACK,
NOT JUST ON USABILITY BUT DESIGN
AS WELL AND WITH THIS PROJECT WE
WANTED TO MAKE SURE THAT WE BOTH
SPEND TIME TO UPDATE AND REFINE
THE APP IN FEEDBACK.
THESE SLIDES REALLY TAKE YOU
THROUGH SOME OF THE WORK THAT
WENT INTO MAKING SURE THAT THE
PLATFORM COULD PERFORM THESE
CAPABILITIES, ONE OF THE MAIN
ACTIVITIES WAS CREATE IN THE
CASE REPORT FORMS, PREVIOUSLY
ESTABLISHED POP DATA ELEMENT SO
THINK OF THIS AS HAVING A SURVEY
THAT YOU GIVE YOUR CLIENT TO
COLLECT DATA, AND WHAT WE HAD TO
DO IS WORK WITH CLINICAL WORK
GROUPS IN ORDER TO DEVELOP DATA
ELEMENTS THAT WOULD FEED INTO
AGAIN THAT CASE REPORTING FORM
FOR CRN INSTRUMENT.
DIFFERENT ACTIVITIES FOR FIRE
SERVER CREATING SMART FIRE APP,
THESE ACTIVITIES WITH JUST THE
BEGINNING ACTIVITIES FOR
CAPABILITIES ONE AND TWO.
WHEN YOU LOOK AT ACTIVITY THREE
AND FOUR IT IS REALLY BUILDING
OUT SOME OF THOSE THINGS THAT WE
DID FOR CAPABILITIES ONE AND TWO
MODIFYING SOME OF THE
INFORMATION FOR THE SMART ON
FIRE APP.
MAKING SURE THAT THE SERVERS ARE
PREPARED TO DEPLOY AND ALSO
WORKING ON THAT PORTION OF THE
PROJECT TO CREATE THIS OUT OF
POPULATION OF INSTRUMENT SO THAT
INCLUDED CREATION OF API
INSPIRED TO MAKE SURE IT WOULD
AUTOPOPULATE.
FOR THE FIFTH AND 6TH
CAPABILITIES IT WAS ADDING
ADDITIONAL MODELS TO THE
QUESTIONNAIRE TO THE APP,
REVAMPING THOSE QUESTIONSES
MAKING MODIFICATIONS TO MAKE
SURE THE STRUCTURES WERE ALIGNED
ACROSS THE DIFFERENT MODULES.
IN THE APP.
SO HERE I PUT THIS ONE IN THE
BACKGROUND BECAUSE SIMILAR TO
THE ONE UP FRONT BUT YOU CAN SEE
HERE THE DIFFERENT MODULES, THAT
WE WERE AVAILABLE THAT I
MENTIONED BEFORE, THE SUY
FIBROIDS, AND WHAT YOU SEE UP
FRONT IS ONCE YOU CLICK ON THAT
FORM, BEING ABLE TO SEE THE DATA
THAT COULD BE COLLECTED, SO
THERE IS AN OPPORTUNITY FOR
PRE-OPERATIVE INFORMATION,
ONTIVE INFORMATION LOOKING AT
POST-OPERATIVE INFORMATION AS
WELL AS ADDITIONAL INFORMATION
ABOUT UNSCHEDULE VISIT DATA.
ONCE YOU CLICK ON ONE OF THESE
MODULES, WHAT YOU WOULD SEE IS
THE OPPORTUNITY TO COLLECT
DEMOGRAPHIC INFORMATION AS WELL
AS SOME HISTORY INFORMATION
ABOUT THE CLIENT OR PATIENT.
AND WHAT WAS INCLUDED
SPECIFICALLY FOR SUY FOR THE
UNIQUE DEVICE IDENTIFIER IS
AGAIN THAT ABILITY TO AUTO
POPULATE.
SO HERE ONE WOULD BE ABLE TO
SCAN A DEVICE OR PUT THE UNIQUE
DEVICE IDENTIFIER INFORMATION
INTO THIS APP AND THEN HAVE IT
AUTOPOPULATE BASED ON THE GLOBAL
DEVICE IDENTIFIER DATA SYSTEM.
SOME OF THE LESSONS LEARNED FROM
THIS PROJECT IS REALLY A PROJECT
CAPACITY BEING ABLE TO ESTABLISH
REASONABLE EXPECTATIONS FOR THE
TIME LINE.
DIFFERENT THINGS THAT NEED TO BE
CONSIDERED IS DATA COLLECTION
WORK FLOW AND HOW THAT CAN VARY
FROM ORGANIZATION TO
ORGANIZATION, AS YOU SAW WE HAD
TWO DIFFERENT PILOT SITES ONE IN
WHICH WE WORKED WITH ONE
REGISTRY AND THEN ANOTHER IN
WHICH WE HAD FOUR ORGANIZATIONS
TO WORK WITH FOR THE ONE PILOT.
MAKE SURE YOU INCLUDE SUFFICIENT
TIME FOR BACK AND FORTH LUKE I
MEGAD BEFORE DURING -- LIKE
MENTIONED BEFORE DEVELOPING CASE
REPORT FORMS, THERE IS WORK THAT
WENT INTO THOSE WORK GROUPS AND
BEING ABLE TO GET TO THAT
FINALCATION REPORT FORM TO BE
USED FOR THIS PROJECT.
LOOK ACT THE INFRASTRUCTURE OF
THEIR REGISTRY AND UNDERSTANDING
HOW TO LIMIT HEALTH IT
IMPLEMENTATIONS.
THE OTHER THING IS LOOKING AT
FIRE RESOURCES THAT WERE
DEVELOPED BASED ON PREVIOUS
EFFORTS, IN ORDER TO BE MORE
EFFECTIVE FOR REGISTRIES ONE
FOCUS OF OUR PROJECT IS WORKING
ON PREVIOUS WORK USED PREVIOUS
WORK, TO BUILD THIS FRAMEWORK SO
USING PREVIOUS STANDARDS AND
PROFILES.
ONE BENEFIT IS WHEN YOU HAVE THE
OPPORTUNITY TO USE A PLATFORM
THAT CAN HOST SEVERAL
REGISTRIES, THAT OFFERS UP THE
OPPORTUNITY TO USE COMMON
COMPONENTS TO ACHIEVE MORE
EFFICIENCIES.
WHERE WE ARE WITH THE WOMEN
HEALTH COORDINATED RESCUE
PROJECT NOW IS BEING ABLE TO
SHARE WITH THE PEOPLE THAT YOU
CAN TAKE THIS WORK THAT WAS
FOCUSED ON WOMEN HEALTH
TECHNOLOGY AND BE ABLE TO USE
THAT IMPLEMENTATION GUIDE AS
COMMON REGISTRY REPORTING
FRAMEWORK SO LOOKING FOR OTHER
OPPORTUNITIES OTHER AREAS THAT
MAY INCLUDE WOMEN HEALTH BUT
LOOKING AT DIFFERENT AREA OF
HEALTH TO USE THIS PARTICULAR IG
AND LESSONS LEARNED FROM PILOT
IMPLEMENTATIONS.
WITH THE SPECIFIC IMPLEMENTATION
SIDE THERE IS MORE WORK THAT WE
NEED TO BE DONE OR THAT
CONTINUES TO BE DONE IN ORDER TO
MAKE SURE THAT THE DATA ELEMENTS
ARE HARMONIZED FOR SPECIFIC IG
AND UPDATED UNDER HL 7, WORKING
TO MAKE SURE THIS IS INCLUDED IN
FUTURE PCOR INITIATIVES, AND NOT
JUST PCOR BUT HERE SHARING THIS
SO THAT YOU WILL TAKE THE
INFORMATION THAT WE HAVE SHARED
TO THINK ABOUT HOW TO REUSE
WITHIN YOUR PROJECTS.
WITH THAT WE LOOK FOR EXPANSION
FOR CLINICAL PARTICIPANTS SO
THAT WE CAN INCREASE THE VALUE
OF REGISTRIES AND REGISTRY
SPECIFICALLY THAT ARE STANDARDS
BASED.
LOOKING AT THE OPPORTUNITY OF
THIS FRAMEWORK TO DECREASE
PROVIDER BURDEN ESPECIALLY FOR
RESEARCHERS AND BEING ABLE TO
COLLECT DATA SHARE DATA AND GET
THAT DATA BACK TO ANSWER SOME OF
YOUR QUESTIONS.
JUST AS CLOSING THESE ARE A LIST
OF FEDERAL PARTNERS AND THAT
PARTICIPATED IN THE PROJECT.
AGAIN, A COLLABORATIVE EFFORT
NOT JUST WITH ONC BUT DIFFERENT
REGISTRIES FOUNDATIONS, HOSPITAL
SYSTEMS, AND OTHER FEDERAL
AGENCIES.
THAT WERE INCLUDED.
WITH THAT I THINK WE ARE ABOUT
READY FOR QUESTIONS AS I BELIEVE
I'M THE LAST SPEAKER.
THANK YOU FOR YOUR TIME.
>> THANK YOU, MS. HENRY.
I WOULD LIKE TO SINCERELY THANK
DR. CROSS BARNET MS. ARGENTIERI
ANFOR YOUR THOUGHT PROVOKING
PRESENTATIONS.
WE HAVE TIME FOR A FEW QUESTIONS
FROM THE AUDIENCE, I ENCOURAGE
EVERYONE TO ENTER QUESTIONS IN
THE Q&A POD AT THE BOTTOM OF
YOUR SCREEN.
LET'S START NOW WITH TWO
QUESTIONS FOR DR. CROSS BARNET.
ONE, IS CAN YOU DESCRIBE THE
THREE CARE MODELS IN MORE
DETAIL?
THAT IS THE BIRTH CENTERS, THE
PRE-NATAL CARE AND MATERNITY
CARE, AND WHAT DO YOU SEE THE
PRIMARY BARRIERS TO INTEGRATING
CARE?
THE WHAT STRATEGIES INTEGRATE
RATHER THIS THAN COORDINATE
CARE?
>> WE ARE DESCRIBING CARE
MODELS.
THE BIRTH CENTERS WERE ALL
MEMBERS OF THE AMERICAN
ASSOCIATION OF BIRTH CENTERS AND
BECAUSE OF THAT HAVE HAD TO
FOLLOW THE STANDARDS THAT ARE
SET FOR BIRTH CENTERS WHICH ARE
AVAILABLE ON ABC'S WEBSITE AND
YOU CAN ALSO LOOK AT THE
ACCREDITATION OF BIRTH CENTERS
WHICH IS THE GROUP ACRONYM IS
CABC WHICH IS COMMITTEE FOR
ACCREDITATION OF BIRTH CENTERS,
IN ANY CASE A BIRTH CENTER --
BIRTH CENTERS BY ALL PRACTICE
WHAT THEY CONSIDER DOB MIDWIFERY
MODEL OF CARE SO INTENSIVE TIME
LOW ENTERVENGES INDIVIDUALIZED
EDUCATION LOTS OF PATIENT
ACTIVATION AN SHARE DECISION
MAKING.
AND BIRTH CENTERS WERE ALL OVER
THE COUNTRY, IN RURAL AREAS IN
URBAN AREAS, BIRTH CENTERS DID
SERVE DISPROPORTIONATE NUMBER OF
WHITE PARTICIPANTS IN STRONG
START BUT MORE ROBUST
PARTICIPATION THROUGH STRONG
START THAN YOU SEE FOR NON-WHITE
WOMEN GENERALLY IN BIRTH CENTERS
AND WE DID HAVE A COUPLE OF
BIRTH CENTERS THAT PRIMARILY
SERVED BLACK AND LATINO WOMEN,
WOMEN WASHINGTON D.C. COMMUNITY
OF HOPE, FAMILY BIRTH CENTER HAD
OUTSTANDING RESULTS IF YOU LOOK
AT THE VOLUME TWO OF THE STRONG
START FOR MOTHERS AND NEWBORN
EVALUATION REPORT YOU CAN SEE
INDIVIDUALIZED REPORTS FOR EACH
SITE AND THEY HAD BIRTH CENTER
IN WASHINGTON D.C HAD BETTER
RESULTS THAN THE AVERAGE FOR
BIRTH CENTERS WHEN AGAIN LOOKING
AT RISK MATCHED COMPARISON
GROUP.
SO THAT WAS THAT.
THEY ALSO IMPLEMENTED PEER
COUNSELING AS PART OF THE STRONG
START INTERVENTION SO THERE WAS
A PEER COUNSELOR AVAILABLE TO DO
ADDITIONAL CARE TOWARD NATION.
HOWEVER, THEY FELT LIKE -- WELL
THE CARE COORDINATORS WERE
HELPFUL THEY WEREN'T REALLY HUGE
VALUE ADD SOME OF THEM KEPT A
COMPONENT OF IT AFTER STRONG
START ENDED FOR REFERRALS AND
THINGS LIKE THAT BUT IF YOU LOOK
BACK AT THE D.C. BIRTH CENTER IN
PARTICULAR THERE HAD BEEN A VERY
SIMILAR EVALUATION OF THAT
PARTICULAR BIRTH CENTER BEFORE
STRONG START WAS IMPLEMENTED AND
THE RESULTS THAT WE SAW IN THAT
BIRTH CENTER FIRST WAS NOT DONE
BY MY AGENCY THE FIRST
EVALUATION WAS DONE AS PART OF
THE SEPARATE PROJECT BUT THE
RESULTS THEY FOUND FOR THE BIRTH
CENTER OUTCOMES WERE ALMOST
IDENTICAL.
BETWEEN THE PRE-STRONG START AND
POST STRONG START POPULATION.
WHICH INDICATES THAT THE
ADDITIONAL SERVICES OF THE PEER
COUNSELOR REALLY DIDN'T -- THAT
WAS SORT OF OUR NATURAL
EXPERIMENT HERE DIDN'T HAVE A
LOT.
THE GROUP PRE-NATAL CARE, IF YOU
LOOK AT THE CENTERING PREGNANCY
MODEL AND THAT IS THE MOST
WIDELY PRACTICED MODEL THEY HAVE
CERTAIN TENANTS THEY EXPECT
PEOPLE TO FOLLOW SO YOU GET A
GROUP OF TEN WOMEN TOGETHER WHO
WERE OF SIMILAR GESTATIONAL AGE
THAT COME IN FOR APPOINTMENT
THAT LASTS AROUND TWO HOURS.
THE FIRST PART OF THAT IS PART
OF THE PATIENT TAKE THEIR OWN
WEIGHT BLOOD PRESSURE AND CHART
IT, THE MODEL DOES SUGGEST OR
ACTUALLY REQUIRE TECHNICALLY IF
YOU ARE ACCREDITED BY THEM, THAT
YOU PROVIDE HEALTHY SNACKS THERE
IS SOCIALIZATION TIME SO PEOPLE
HAVE A CHANCE TO JUST CHAT AND
BOND AND WHILE THEY ARE DOING
THEIR WEIGHT AND BLOOD PRESSURE
WHICH OBVIOUSLY DOESN'T TAKE
TIME GO IN A PRIVATE AREA, FOR
QUICK HEALTH SCREEN SO BELLY
CHECK HEART RATE ANSWERING ANY
MEDICAL QUESTIONS, AND IF THE
PERSON DOES HAVE MEDICAL NEEDS
THAT CHECK UP THEY HAVE A
SEPARATE APPOINTMENT FOR HIGH
RISK CONSULTATION.
BUT PROVIDING EVERYTHING IS FINE
YOU GO INTO THE FACILITY TO
CUSHION FOR 60 TO 90 MINUTES THE
GROUP TALKS ABOUT A TOPIC THAT
MIGHT BE SEWNS OF EARLY LABOR OR
PROBLEMS THAT YOU KNOW WHERE YOU
KNOW YOU NEED TO COULD YOUR
DOCTOR OR GO TO THE ER OR BREAST
FEEDING OR FAMILY PLANNING.
AND THERE ARE TEN SESSIONS, EACH
ONE FOCUSED ON ONE OF THESE
TOPICS AND THE WOMEN ARE -- IT
IS SUPPOSED TO BE FACILITATED
DID CUSHION.
SO THERE ARE -- DISCUSSION SO
THERE ARE PROVIDERS HELPING LEAD
THAT DISCUSSION BUT IT IS
SUPPOSED TO BE INFORMATION
SHARING AMONG THE PEOPLE AND NOT
QUOTE UNQUOTE CLASS.
THE MATERNITY CARE MODEL AS
INDICATED EARLIER JUST IT HAD
THE MOST VARIATION IN IT.
SO WE HAD SOME PEOPLE DOING IN
PERSON CONSULTATION, SOME DOING
TELEPHONE CONSULTATION, SOME
DOING A COMBINATION.
SOMETIMES THE CARE COORDINATOR
WAS A COMMUNITY HEALTH WORKER,
SOMETIMES A SOCIAL WORKER
SOMETIMES A NURSE.
SOMETIMES VARIETY OF THOSE
QUALIFICATIONS WHAT WE HEARD
MOST OFTEN WAS THE MOST
IMPORTANT QUALITIES IN CARE
COORDINATORS WAS PERSONAL
CHARACTERISTICS THAN
CREDENTIALING, THE ABILITY TO
THE WOMEN THEY WERE WORKING WITH
WAS THE MOST IMPORTANT THING
ABOUT WHAT THEY HAVE DONE.
SOME OF THE PROGRAMS HAD
PROTOCOL FOR MEETING LIKE YOU
GET -- YOU HAVE CONTACT IN YOUR
FIRST TRIMESTER SECOND TRIMESTER
THIRD AND POSTPARTUM, OTHERS
WERE EVERY TIME YOU COME IN YOU
TALK TO THE PERSON.
THEN CALL HER IN BETWEEN.
IF YOU NEED OTHER CONSULTATION
OR SHE WILL MEET YOU SOMEWHERE.
SO IT REALLY THE INTENSITY
VARIED TREMENDOUSLY, THE
QUALIFICATIONS OF THE PEOPLE
VARIED Z THE DEPTH IN WHICH THEY
TALKED ABOUT THINGS VARIED A
LOT.
BUT I DIDN'T MATTER WHAT IT WAS.
NONE HAD MUCH IMPACTMENT PEOPLE
LIKED IT, IT WASN'T AS IF PEOPLE
DIDN'T VALUE TIME THOSE FOLKS
PUT IN OR DIDN'T ENJOY TALKING
WITH THEM OR DIDN'T FEEL LIKE IT
IMPROVED THEIR CARE EXPERIENCE.
BUT AS FAR AS OUTCOMES DIDN'T
MOVE THE NEEDLE AND IT COSTS
MONEY.
SOME CASES COST MORE MONEY THAN
MEDICAID SYSTEM IN ADDITION TO
REFER FORD CARE AND GOING BUT
THAT DIDN'T IMPROVE OUTCOMES
EITHER.
WE KNOW THERE'S VERY LITTLE
MEDICALLY WE CAN DO TO PREVENT
PRE-TERM BIRTH.
MORE THAN ANYTHING IT TENDS TO
BE MONITORING SOMEBODY.
WHICH MIGHT HELP PREVENT
MORTALITY FOR MOM OR INFANT, NOT
LIKE WE DON'T WANT TO DO THAT
BUT IF YOU HAVE SOMEBODY WITH
SEVERE PREECLAMPSIA, SHE IS
LIKELY TO HAVE PRE-TERM BIRTH
ANYWAY, YOU WILL NOTE IF BLOOD
PRESSURE GOES HIGH ENOUGH YOU
HAVE TO DO EMERGENCY INDUCTION
OR C-SECTION, PRE-TERM BABY, YOU
MIGHT PREVENT BY CATCHING THE
CONDITION BEFORE IT BECOMES SO
SEVERE THE BABY DIES.
SO IT DIDN'T OHIO DIDN'T REALLY
IMPACT THE OUTCOMES AT ALL.
IN ANY MEANINGFUL WAY.
THERE IS A HOME VISITING ARM
THAT WAS DONE THROUGH HRSA.
THAT LOOKED A THE IMPACT OF
NURSE FAMILY PARTNERSHIP AND
HEALTHY FAMILIES AMERICA
PRE-NATAL CONTACT ON BIRTH
OUTCOMES AND DIDN'T FIND
SUBSTANTIAL IMPACT.
THERE WERE IMPACT OF THOSE
PROGRAMS FOR THE BABIES LATER
AND I DON'T KNOW WHETHER OR NOT
THAT HAD ANYTHING TO DO WITH
WHAT HAPPENED PRE-NATALLY BUT
THOSE HOME VISITING PROGRAMS DID
HAVE POSITIVE EFFECTS ON
CHILDREN BUT NO IMPACT ON BIRTH
OUTCOMES.
>> THANK YOU DR. CROSS BARNET.
>> DO YOU WANT ME TO ANSWER THE
SECOND COORDINATING CARE?
>> CERTAINLY, WE HAVE EXTRA
TIME.
>> SO CARE COORDINATION TENDS TO
BE ASSIGNED TO A SPECIFIC PERSON
WHO SAYS WHAT DO YOU NEED, THERE
MAYBE SCREENING ASSESSMENTS
DONE, HEALTH RELATED SOCIAL
NEEDS SCREENING, WE DID HAVE
THAT IN STRONG START WE SCREEN
FOR FOOD INSECURITY HOUSING
INSECURITY, DEPRESSION, ANXIETY,
SMOKING, ALCOHOL USE
UNEMPLOYMENT, WE SCREEN FOR A
LOT.
REALLY INITIALLY ANNOYED HOW
MUCH WE WERE SCREENING FOR
THOUGH A LOT OF THEM KEPT
SCREENING AFTER THE PROGRAM WAS
OVER SO THEY ONCE THEY
INCORPORATED INTO PRACTICE, I
THINK THAT IS INTERESTING TOO,
THEY SAY THEY WANT CARE
COORDINATION BUT RELUCTANT TO DO
THE SCREENING THAT YOU WOULD
NEED TO DO EFFECTIVE CARE
COORDINATION.
BUT THEN WHEN THEY INTEGRATED
THAT IT DIDN'T MATTER MUCH.
INTEGRATING CARE IS CHALLENGING
BECAUSE THERE'S SO MANY SYSTEMS.
WE DON'T HAVE ONE EHR THAT
EVERYBODY USE, SOME USE EPIC,
SOME HAVE THEIR OWN SYSTEMS.
THEY DON'T NECESSARILY TALK TO
EACH OTHER.
THERE ARE REGULATIONS AROUND
SHARING DATA WITHIN THE HEALTH
SYSTEM THROUGH HIPAA BUT IF YOU
ARE WORKING WITH KIDS,
INTEGRATED KIDS MODEL FRPA HAS
RESTRICTIONS ON WHAT YOU CAN
SHARE FROM THE SCHOOL SYSTEM AND
THE CHILD WELFARE SYSTEM HAS
VERY HIGHLY PROTECTED DATA
JUVENILE JUSTICE SYSTEMS OR
JUSTICE SYSTEMS IN GENERAL TEND
TO HAVE HIGHLY PROTECTED DATA TO
PROTECT PRIVACY, THAT IS
IMPORTANT BUT IT INTERFERES WITH
THE ABILITY OF PROVIDERS TO
UNDERSTAND EVERYTHING THAT IT
NEEDS TO TAKE TO PROVIDE SOMEONE
WITH CARE, WE DEFINITELY SAW, WE
DID FUND THROUGH BOTH INK AND
MOM WE GAVE MONEY TO IMPROVE
INFRASTRUCTURE TO DO THESE
SYSTEMS BUT WE STILL GOT PUSH
BACK.
SO MOM PEOPLE WOULD SAY, HOW DO
YOU EXPECT US TO DO THIS?
THAT IS WHAT WE GAVE YOU MONEY
FOR.
BECAUSE ACTUALLY LIKE PROVIDE
MEDICATION ASSISTED TREATMENT
FOR OPIOID USE DISORDER WE WANT
EVERYONE TO DO THAT WE WAN MORE
EFFECTIVE PROGRAMMING, MEDICARE
ALREADY COVERS THAT, YOU ARE NOT
COVERING THAT WITH OUR PROGRAM
FUNDS, THE PROGRAM FUNDS IMPROVE
THE SYSTEM.
SO OUT OF THE TEN AWARDEES WE
ORIGINALLY STARTED WITH, TWO
DROPPED OUT.
AND BUT AMONG THE REMAINING
EIGHT EVEN THOUGH THERE WERE A
LOT OF CHALLENGES THEY REALLY
FIGURED IT OUT, THEY WORKED WITH
THEIR EHR, THEY WORKED WITH
THEIR HEALTH INFORMATION
EXCHANGES, NOT SAYING PERFECT WE
DON'T HAVE ANY RESULTS YET WE
JUST STARTED ENROLLING PEOPLE IN
JULY.
SO WE WILL KNOW MORE AS TIME
GOES ON BUT INTEGRATING THOSE
SYSTEMS WAS CHALLENGING THEY HAD
18 MONTHS TO GET OFF THE GROUND,
TWO WANTED SICK MORE MONTHS,
EXTENSION -- SIX MORE MONTHS
EXTENSION SO TWO NOT STARTING
UNTIL JANUARY AND WE DON'T KNOW
HOW WELL IT WORKED WHAT WE DO
KNOW IS THE CARE COORDINATION
DOESN'T WORK ALONE SO WE ARE
TRYING TO BUILD ON THAT.
>> THANK YOU VERY MUCH, DR.
CROSS BARNET.
WE HAVE A QUESTION FOR
MS.ARGENTIERI.
CAN YOU SPEAK TO THE ETHICAL
ISSUES AROUND INTEGRATING
PATIENT RECORDS BETWEEN MULTIPLE
FAMILY MEMBERS, FOR EXAMPLE
MOTHER AND CHILD, TO FACILITATE
WHOLE FAMILY CARE, SUCH AS
PERINATAL DEPRESSION SCREENING
AND TWO GENERATION APPROACH TO
CARE?
SUCH AS REFERRALS FOR PARENTING
PROGRAMS?
AND ALSO DOES ONC HAVE
RECOMMENDATIONS FOR OR PROJECTS
AROUND BEST PRACTICE FOR THESE
TYPES OF INTEGRATIONS?
>> I'M NOT SURE IF RYAN IS ON
BUT I KNOW AROUND THAT I CAN'T
THINK OF ANYTHING TO ADD TO THAT
SPECIFIC -- BUT WHEN WE TALK
INTEGRATING PATIENT RECORDS,
JUST INTEGRATING DATA, FROM
DIFFERENT SOURCES WHAT WE ARE
LOOKING INTO IS INFORMED CONSENT
AND LOOKING AT SPECIFIC DATA
ELEMENTS TO GIVE PERMISSION.
FOR SPECIFIC DATA THAT MAYBE
ABLE TO BE SHARED.
ACROSS RECORDS.
>> FOR DR. CROSS BARNET.
SO INTERESTING SOCIAL
INTERACTION DIDN'T IMPROVE
OUTCOMES.
WHAT IS YOUR HYPOTHESIS WHY THIS
MIGHT BE?
>> SO WE DON'T KNOW IT NEVER
IMPROVED ANYTHING.
WE WERE MEASURING FACTORS,
LOOKING AT BIRTH OUTCOMES, WE
TRACE THE MOM AND BABY THROUGH
FIRST YEAR AS FAR AS COST COSTS WENT
AND UTILIZATION, EMERGENCY ROOM
VISITS, HOSPITALIZATION, THINGS
LIKE THAT.
SO COULD HAVE HELPED WITH
ENGAGEMENT WITH THE SYSTEM, MORE
TRUST IN HEALTHCARE PROVIDERS OR
THINGS LIKE THAT.
I DON'T WANT TO -- I DON'T WANT
TO IMPLY IT DIDN'T DO ANYTHING.
BUT IF YOU LOOK AT -- THERE'S
COCHRAN REVIEWS ABOUT MIDWIFERY
MODEL OF CARE LOOKING AT WHAT
THEY CALL MIDWIFERY CONTINUITY
MODEL WHICH IS WHAT IS PROVIDED
IN THE BIRTH CENTER AND ALSO
FOUND REDUCTION IN PRE-TERM
BIRTH THERE AND THAT WAS THROUGH
MORE RANDOMIZE CONTROL TRIALS AS
WELL SO FINDINGS AREN'T
NECESSARILY SUR SPRUCING.
I DO THINK ENGAGING WITH YOUR
ACTUAL PROVIDE ERATHER THAN
ANSWER LAYER PERSON IS -- CAN BE
REALLY CRITICAL.
FOR THAT PERSON BEING ABLE TO
MEET NEEDS.
IT CAN HELP ALSO TO BE HAVE MORE
CENTRALIZED WITH ONE PERSON SO
IF YOU SAY THIS PERSON HAS A
NUTRITIONAL NEED, AND THIS
PERSON HAS BEHAVIORAL HEALTH
NEEDS AND WE'LL SEND TO SOCIAL
WORKER FOR THERAPY, AND THIS
PERSON HAS THIS AND WE WILL SEND
TO THIS PERSON.
PROBABLY NONE OF US WANT TO TALK
TO HALF A DOZEN STRAININGSER
ABOUT OUR PERSONAL BUSINESS AND
THE MIDWIFERY MODEL REALLY
CENTERS MORE OF THAT WITH
PRIMARY PROVIDER NOT THAT SHE
WOULDN'T REFER OUT FOR SOMEBODY
WITH INTENSIVE NEED BUT THEY
TALK FOOD.
THERE IS A LOT OF TIME TO TALK
ABOUT WHAT ARE YOU'DING AND MAKE
A PLAN.
SO FORTH AND MORE FOLLOW-UP FROM
THAT PERSON.
SO IT IS JUST MORE AROUND THAT
REAL RELATIONSHIP BUILDING.
AS OPPOSED TO -- WE REALLY HAVE
I WILL SAY IN MATERNITY CARE
HOMES MORE LIKELY TO SEE
INFORMATION COMING THROUGH TO US
THAT WOULD SAY THINGS LIKE WE
WILL SEE 500 PREGNANCIES AND I
ALWAYS THINK TWO PREGNANCIES
WALK INTO A BAR, ONE SAYS TO --
YOU KNOW, IT IS SUPPOSED TO
REALLY THINKING OF THEM AS
PEOPLE.
AND YOU HEAR THAT ALL TIME IN
MEDICINE.
WHERE PEOPLE ARE TIRED AND THEY
ARE SEEING PATIENT AFTER PATIENT
AFTER PATIENT, YOU START TALKING
ABOUT KIDMY THE ROOM THREE.
-- KIDNEY IN ROOM THREE.
THERE IS A FAIR AMOUNT OF THAT
THAT GOES ON IN THE KINDS OF
CLINICAL CARE PROVIDED FOR
PRE-NATAL CARE.
WE HAVE PEOPLE WHO ARE REALLY
OVERQUALIFIED FOR PROVIDER BASIC
PRE-NATAL CARE, DOING THAT JOB.
SO WE ARE PAYING A LOT OF MONEY
TO HAVE SOMEBODY WHO IS
OBSTETRICIAN OR MATERNAL FETAL
MEDICINE SPECIALIST, REALLY
OFFERING MUCH HIGHER LEVEL OF
CARE THAN AVERAGE PREGNANT
PERSON NEEDS.
THEN BECAUSE YOU ARE PAYING THEM
FOR THEIR EXPERTISE THEY DON'T
HAVE THE TIME TO SPEND WITH THIS
PERSON.
AND THEY ALSO DON'T HAVE THE
TRAINING AND RELATIONSHIP BASED
CARE.
THEY ARE TRAINED TO DEAL WITH
MEDICAL PROBLEMS.
WE ARE REALLY IMPORTANT PART OF
THE CARE TEAM.
WE DEFINITELY DON'T WANT OUR
BIRTH CENTER FOLKS REFER PEOPLE
ALL THE TIME WHEN THEY NEEDED A
HIGHER LEVEL OF CARE AND AS I
SAID WE HAD HALF THE PEOPLE
GIVING BIRTH IN THE HOSPITAL,
THERE WAS PEOPLE DEFINITELY HAD
CESAREANS, IT WAS NOT AS IF
THERE WERE -- WASN'T A NEED FOR
DOCTORS WITHIN THAT MODEL.
THERE IS.
BUT THE LOW RISK PEOPLE WERE
PROVIDED WITH APPROPRIATE LOW
RISK CARE THAT WAS MUCH MORE
FOCUSED ON THEIR SOCIAL NEEDS
THROUGH ONE SMALL HANDFUL OF
PEOPLE.
AND THEY WERE NOT NECESSARILY
HAVING TO GO TO 50 DIFFERENT
PLACES.
>> THANK YOU, DR. CROSS BARNET.
QUESTION FOR MS. HENRY.
WOMEN'S HEALTH TECHNOLOGIES
COORDINATED REGISTRY NETWORK
INTEREST GROUP WAS DEVELOPED TO
SERVE AS COMMON REGISTRY
REPORTING FRAMEWORK BUILT FROM
PREVIOUSLY DEVELOPED FAST
HEALTHCARE INTEROPERABILITY
RESOURCES.
ARE THERE OTHER RESOURCES
AVAILABLE TO SUPPORT RESEARCHERS
INTERESTED IN ENHANCING DATA
COLLECTION EFFORTS?
>> YES, THANK YOU, FOR THE
QUESTION.
SO SOME OF THE WORK THAT ONC IS
FOCUSED ON IS ADVANCING HEALTH
EQUITY OPPORTUNITIES THROUGH THE
USE OF CERTIFIED HEALTH IT RACE
AND ETHNICITY CAPABILITIES AS
WELL AS CODES.
SO WE WORKED WITH STAKEHOLDERS
TO INCLUDE SOCIAL DETERMINANTS
OF HEALTH DATA ELEMENTS AS WELL
AS SEXUAL ORIENTATION AND
GENDER, IDENTITY, DATA ELEMENTS
WHAT WE CALL USCDI THAT STANDS
FOR U.S. CORE DATA ELEMENTS FOR
INTEROPERABILITY.
AND THAT IS WHAT WE BASE THE
DEVELOPMENT OF SOME OF OUR
STANDARDS OFF OF SO WHEN YOU
TAKE SOMETHING LIKE COORDINATED
REGISTRY NETWORK AND DEVELOPMENT
OF THAT IMPLEMENTATION GUIDE
BECAUSE WE PROVIDED THESE NEW
DATA ELEMENTS IN THE U.S.CDI IT
PRESENTS THEM AS OPPORTUNITY TO
BE INCLUDED IN ADVANCING
IMPLEMENTATION GUIDE DEVELOP
FORD REGISTRY SO GOOD NEWS FOR
RESEARCHERS, THAT THESE DATA
ELEMENTS ARE OUT THERE FOR THEM
TO USE TO ENHANCE REGISTRIES AN
DATA COLLECTION EFFORTS.
>> THANK YOU, MS. HENRY.
>> HELLO.
>> QUESTION FOR DR. CROSS
BARNET.
I THINK YOU HAVE STARTED
ADDRESSING THIS.
SHOULD CARE COORDINATION BE PART
OF INTEGRATED CARE?
AND IF SO, HOW?
>> REALLY GREAT QUESTION.
I THINK A LOT OF PEOPLE DO NEED
IT.
I THINK ONE OF THE ISSUES THAT
YOU SEE, THIS SOMETHING THAT WE
CONFRONTED WITH INTEGRATED CARE
FOR KIDS IN PARTICULAR BECAUSE
WE ARE LOOKING AT SO MANY
SYSTEMS IS EVEN CARE
COORDINATION IS OFTEN NOT WELL
COORDINATE SOD YOU MAY HAVE A
CHILD WHO HAS SOMEBODY
COORDINATING ISSUES MANY THE
EDUCATION SYSTEM, SOMEBODY ELSE
WHO IS COORDINATING BEHAVIORAL
HEALTHCARE, COORDINATING SOME
SPECIALIZED MEDICAL NEED THEY
HAVE ASTHMA CARE SO THE FAMILY
IS NOT JUST DEALING WITH ALL
THESE MULTIPLE SOCIAL MEDICAL
ISSUES BUT ALSO DEALING WITH
HALF DOZEN CARE COORDINATORS.
ONE OF THE THINGS THAT INK TRIED
TO DO IS ESTABLISH SINGLE POINT
OF CARE.
SO BASICALLY SOMEBODY WHO
COORDINATES COORDINATION.
SO THAT THE FAMILIES ACTUALLY
ONLY INTERACTING WITH ONE
PERSON.
I ALSO THINK OF THIS ISSUES
AROUND DATA AND INFORMATION
SHARING MAKE CARE COORDINATION
IT MORE EFFECTIVE.
AN EXAMPLE WHICH IS LOW DOSE
ASPIRIN SOMETHING WE KNOW HELPS
PREVENT PREECLAMPSIA, THERE IS
RECOMMENDATIONS REINFORCED BY
THE U.S. PREVENTIVE SERVICES
TASK FORCE 60 MONTHS AGO AND
ASKED PEEP STRONG START IF THEY
WERE PROVIDING ASPIRIN TO
PATIENTS AT RISK FOR
PREECLAMPSIA, BECAUSE PEOPLE HAD
RISK FACTORS INCLUDING MODERATE
RISK FACTORS SO IF YOU HAVE
MULTIPLE MODERATE RISK FACTORS
YOU ARE ELIGIBLE FOR ATTEMPTING
ASPIRIN.
WE FOUND IT WAS RANDOM WHETHER
OR NOT PEOPLE DID, IT DIDN'T
SEEM CORRELATE WITH THE TYPE OF
PROVIDER, OR WHERE THEY WERE
PRACTICING, ASIDE FROM A COUPLE
OF ACADEMIC MEDICAL CENTERS THAT
DID IT CONSISTENTLY BUT EVEN
AMONG ACADEMIC MEDICAL CENTERS
WE HAD ONE THERE THEY WERE LIKE
OUR HEAD OB SUSOR DOESN'T THINK
IT WORKS SO WE DON'T DO IT.
THINGS LIKE THAT.
BUT IT WAS PROVIDER SPECIFIC SO
SOME OFFERED IT, SOME DIDN'T.
THE PERSON WOULD SEE MULTIPLE
PROVIDERS, AND SO SOME PEOPLE
WOULD BE RECOMMENDING IT AND
WHETHER SHE FOLLOWED UP DEPENDED
WHETHER OR NOT NEXT WAS READING
THE CHART AND WHEN WE TALK TO
COMMUNITY HEALTH WORKERS AND
CARE COORDINATORS NO MATTER
CREDENTIALS, MY FAVORITE QUOTE I
KNOW NOTHING ABOUT THE ASPIRIN
THING AND THERE WAS A LOT OF
THAT.
CARE COORDINATORS HAD NO IDEA
WHAT HAD BEEN PRESCRIBED TO
THESE FOLKS OR RECOMMENDED TO
THEM.
SO THERE WAS NO OPPORTUNITY FOR
THEM TO ANSWER QUESTIONS OR
FOLLOW-UP PEOPLE GET MIXED
MESSAGE IT IS PHARMACIST WOULD
BE LIKE OH NO YOU DON'T WANT TO
TAKE THAT.
AND THERE WAS JUST -- THERE
WASN'T ENOUGH COMMUNICATION TO
REALLY KEEP THAT GOING AND HELP
THE PERSON.
SO I THINK CARE COORDINATION IS
HELPFUL, IT DEPENDS IN PART WHAT
RESOURCES ARE AVAILABLE, WHAT
COMMUNICATION AMONG PROVIDERS
AND CARE COORDINATORS.
AND WHAT KIND OF COORDINATION
ACROSS THE BOARD.
YOU ALSO HAVE CONNECTION.
AN EXAMPLE FROM LOS ANGELES
STRONG START WE HAD -- THEY WERE
SERVING A VERY LARGE LATINA
COMMUNITY, AND THEY HIRED CARE
COORDINATORS WHO WERE THEMSELVES
LATINA.
BUT THEY TENDED TO BE OLDER AND
OFTEN QUITE RELIGIOUS.
AND THEY WERE DEALING WITH YOUNG
WOMEN MOST STRONG START
PARTICIPANTS WERE IN THEIR EARLY
20s.
AND THEY WEREN'T CONNECTING WITH
THE PEOPLE THEY WERE OFTEN
JUDGMENTAL OF THE THINGS THEY
WERE DOING, FELT LIKE THESE
GIRLS WERE WRONG FOR NOT BEING
MARRIED OR PARTYING TOO HARD OR
JUST NOT DOING THINGS SPECIFIC
WAY, SO JUST BECAUSE YOU ARE
PULLING SOMEBODY FROM A
COMMUNITY DOESN'T MEAN THEY ARE
-- IT IS NOT JUST LIKE OH LOOK
THEY ARE THE SAME COLOR LET'S
THROW THEM IN A ROOM TOGETHER.
YOU HAVE TO THINK MORE ABOUT THE
WAY PEOPLE ARE MAKING
CONNECTIONS AND WHETHER OR NOT
THEY REALLY ARE FROM THE SAME
BACKGROUND AND WHAT THAT MEANS.
I ACTUALLY WATCHED A CARE
COORDINATOR INTERACTING WITH
SOME PEOPLE AT ONE OF THE BIRTH
CENTERS AND SHE WAS A NURSE WHO
HAD HERSELF BEEN A MEDICAID
PARTICIPANT.
BUT SHE JUST HAD A VERY GRUFF
MANNER, AND I WOULDN'T HAVE
WANTED TO TALK TO HER.
SO SOME IS LIKE SOMEBODY MIGHT
LOOK LIKE THEY ARE THE RIGHT
KIND OF PERSON BUT ARE THEY
REALLY MAKING CONNECTIONS WITH
PEOPLE, THAT CAN BE A BIG PART
TOO.
THERE IS A LOT.
WHAT HAPPENS IS IT IS HARD TO
KNOW WHAT TO DO.
AND YOU HAVE THESE BUSY
PHYSICIANS WHO DON'T KNOW HOW TO
HAVE THE TIME TO HANDLE THESE
PROBLEMS, LIKE OH WE WILL HIRE A
CARE COORDINATOR, THEY WILL
HANDLE IT AND YET WHAT ARE THEY
HANDLING AND WHAT TOOLS, WHAT
COMMUNICATION IS THERE, IT SEEMS
LIKE AN EASY FIX AND IT IS NOT,
IF THIS PROBLEM WERE EASILY
FIXED WE WOULD HAVE FIXED IT.
>> I DON'T THINK ENOUGH CAN BE
SAID ABOUT THE IMPORTANCE OF
THAT POINT YOU JUST MADE ABOUT
LOOKING AT PEOPLE AS MONOLITHS
AND FAILING TO RECOGNIZE THERE
ARE INDIVIDUAL DIFFERENCES AN
MICROCULTURES WITHIN OUR RACIAL
ETHNIC GROUPS.
A QUESTION FROM MS. HENRY.
ADDITIONAL COMPONENTS A TEAM
SHOULD CONSIDER WHEN DEVELOPING
A COORDINATED HEALTH NETWORK OR
ANY INFRASTRUCTURE TO SUPPORT
HEALTHCARE SYSTEMS?
>> THANKS FOR THE QUESTION.
AS EMERGED IN THE PRESENTATION,
THERE ARE DIFFERENCES AMONG RING
INDUSTRIES ON THE PLATFORMSTHEY
CURRENTLY HAVE.
SO ONE THING TO HIGHLIGHT FROM
THE PRESENTATION IS THINKING
READINESS FOR HEALTH IT TOOLS
WHEN TALKING DIFFERENT
STAKEHOLDERS.
AND THE TEAM SEEKING TO USE, THE
OTHER THING IS JUST THINKING
MORE NOT JUST ABOUT
INFRASTRUCTURE OVERALL BUT ALSO
LOOKING AT WHAT GOVERNMENTS
LOOKS LIKE FOR THAT TEAM LOOKING
TO DEVELOP COORDINATOR REGISTRY
NETWORK, BEING ABLE TO REALLY
TALK ABOUT THE ROLES AND
RESPONSIBILITIES FOR EACH
STAKEHOLDER THAT YOU PLAN TO
HAVE AS PART OF THAT NETWORK.
ARE YOUR TEAM DEVELOPING OUT
HEALTH IT FOR RESEARCH OR
PROJECTS.
BUT NOT JUST THAT, LOOKING AT
THE OPPORTUNITY TAKING ONE IDEA
TO -- THAT MAY TAKE A YEAR OR
TWO HOW YOU EXPAND THAT WORK
OUT.
BEYOND INITIAL STAYS LOOKING
WAYS TO MAINTAIN SUSTAINABILITY.
LAST HIGHLIGHT, WE FOCUS ON
RESEARCH AND TALK ABOUT PATIENT,
THE CLIENT, AND WORKING WITH
CLINICIANS, BUT ONE THING THOUGH
IT MAY BE A HEALTH IT PRODUCT
YOU ARE DEVELOPING AND SO
NETWORK AMONG YOUR DEVELOPERS AS
WELL AS FEDERAL AGENCIES FOR US,
IN YOUR HEALTH SYSTEMS CONSIDER
THE ROLE OF THE PATIENT.
LOOK AT PATIENT ENGAGEMENT, MAY
PLAY A ROLE DEVELOPING OUT THESE
HEALTH IT TOOLS AND PLATFORMS.
>> THANK YOU.
I REGRET TO SAY WE HAVE ONE OUT
OF TIME FOR QUESTIONS BUT WE
WILL DO OUR BEST TO ADDRESS ANY
UNANSWERED QUESTIONS IN EMAIL
THE NEXT TWO WEEKS.
THANKS TO ALL OF OUR SPEAKERS
FOR THEIR OUTSTANDING
PRESENTATIONS AND THE VERY
ENGAGING Q&A SESSION.
PLEASE STAY WITH US NOW AS WE
MOVE TO WHAT PROMISES TO BE A
VERY LIVELY DISCUSSION AMONG OUR
CO-CHAIRS, PANELISTS FROM PAST
SESSIONS, AND OUR WORKSHOP
PLANNING COMMITTEE DURING OUR
WORKSHOP CLOSE OUT.
I WILL TURN IT OVER TO YOU,
MARRAH.
>> THANK YOU, DEIDRA.
SESSION FIVE PROVIDED TYPES OF
INFRASTRUCTURE WE NEED TO
SUPPORT CONTINUUMS OF CARE, FOR
UNDERRESOURCE AND MEDICALLY
UNDERSERVED WOMEN AN GIRLS.
OUR FIRST SPEAKER PRESENTED THE
MOM TO BASSINET MODEL DISCUSSING
INFRASTRUCTURE NEEDED TO ENSURE
INFANT HEALTH IS PROTECTED BY
TREATING THE MOTHERS CO-EXISTING
CONDITIONS.
THE OUTCOMES DATA WERE COMPARED
BY THE TYPE OF SYSTEM THAT THE
MOTHER INTERFACE WITH FOR CARE
AND RISK MATCH TO THE EHR WHERE
STRONG STARTS PROGRAM SHOW BIRTH
CENTERS AND GROUP PRE-NATAL CARE
DECREASED THE EQUITY GAP, BY
PROVIDERS ACTUALLY SPENDING MORE
TIME WITH THE PATIENT AND
PROVIDING INFRASTRUCTURE FOR
CARE CONTINUE ANNUITY.
BUT THERE WERE STILL REMAINING
STRUCTURAL BARRIERS, LIMITED
RESOURCES SUCH AS ACCESS TO
TRANSPORTATION, OR TYPES OF
SERVICES THAT WERE AVAILABLE
SUCH AS LIMITED ACCESS TO MENTAL
HEALTH WORKERS, OR LACK OF THE
NEEDED SOCIAL SERVICES FOR THE
WOMEN.
THE KEY TO SUCCESS HERE HOWEVER
WAS CONTINUITY WHERE
CENTRALIZING RESOURCES AND
INFORMATION REALLY BUILT
RELATIONSHIPS BY PROVIDING A
POINT OF INTERFACE FOR WOMEN TO
FIND RELIABLE CARE.
WE ALSO HEARD FROM ONC WITH
THEIR PROGRAMS TO EXPAND PATIENT
ACCESS FOR HEALTH EQUITY AN CARE
BY THEIR IMPLEMENTATION
TECHNOLOGY DESIGN AND HOW YOU
CAN IMPROVE ACCESS TO CARE FOR
WOMEN BY INCREASING THEIR HEALTH
INFORMATION KEY TOUCH POINTS
DURING THEIR LIVES.
THESE TALKS HIGHLIGHTED WHAT
INFRASTRUCTURE IS NEEDED, DATA
STANDARDS AND THOUSAND IMPLEMENT
THESE PROGRAMS.
INTERDEPARTMENTAL PROJECT WAS
IMPLEMENTED TO SUPPORT WOMEN'S
HEALTH HE CAN THENOLOGY IN A
COORDINATED REGISTRY NETWORK
WHERE THE VISION WAS TO
COORDINATE DATA WITH TARGETED
GOAL TO IMPROVE WOMEN HEALTH
USING SELECTED FEMALE SPECIFIC
HEALTH CONDITIONS AND HOW THE
PILOT PROGRAM WAS PLEA
AGREEMENTED FOR THE TECHNOLOGY
PROGRAM TO ADDRESS THESE COMPLEX
MEDICAL NEEDS.
MANY LESSONS LEARNED FROM THIS
PILOT AND RESOURCES ARE STILL
BEING GENERATE FORD THIS
PROGRAM.
SO NOW WE WILL ENTER OUR FINAL
PANEL DISCUSSION WHICH WILL BE
MODERATED BY OUR WORKSHOP
CO-CHAIRS DR.S CHANDER AND
JOHNSON.
AND IT WILL ALSO INCLUDE
PANELISTS FROM YESTERDAY AND
TODAY'S PANEL.
THIS IS AN OPPORTUNITY FOR THEM
TO HAVE AN OPEN DISCUSSION
AROUND SOME OF THE GOALS OF THE
WORKSHOP AND I WILL START BY
POSING A FEW FOR -- THERE IS A
COUPLE OF TOPICS I THINK I LIKE
Y'ALL TO TALK ABOUT AND I WILL
REPOST THEM IN THE CHAT SO WE
CAN CONTINUE THE CONVERSATION.
FIRST IS HOW DO WE PROMOTE
EDUCATION AND TRAINING FOR
INTEGRATIVE HEALTHCARE AND
CONTINUUMS OF CARE?
SECOND, WHAT IS REALLY NEEDED TO
SUPPORT INTEGRATION AND
COORDINATION OF HEALTHCARE
SERVICES TO MEET THE HEALTH AND
SOCIAL NEEDS OF RACIAL ETHNIC
UNDERSERVED WOMEN OF
REPRODUCTIVE AGE?
AND FINALLY, THIS IS REALLY
IMPORTANT AS WE HAVE A LOT OF
STAKEHOLDERS NOT ONLY THAT WERE
ON THE PANEL BUT ALSO IN THE OFF
YENS, HOW CAN WE LEVERAGE
EXISTING FEDERAL STATE AND LOCAL
RESOURCE, AND COLLABORATION TO
ALIGN COMMUNITY AND CLINICAL
SERVICES ALL WITH THE GOAL OF
DRESSING MULTI-MORBIDITY ACROSS
THE LIFE SPAN.
SO I WILL PUT IN THE CHAT AND
WELCOME DISCUSSION FROM ALL
PANELISTS.
WONDERING MS. ARGENTIERI IF MY
PANELIST VERSUS THOUGHTS, YOU
CAN RAISE YOUR HAND, MIGHT BE
EASIER TO FAIL SILL AT A TIME
VIA ZOOM.
-- FACILITATE VIA ZOOM.
KIM.
>> IN I DRESS THE FIRST QUESTION
HOW TO PROMOTE EDUCATION AND
TRAINING.
I THINK IT GETS BACK TO RAISING
AWARENESS THAT EM WITH'S HEALTH
INCLUDES EVERYTHING -- WOMEN'S
HEALTH INCLUDES ANY MELT
CONDITION NOT ONLY REPRODUCTIVE
HEALTH.
SO AS WE ARE ADDRESSING
EDUCATION IT IS GETTING THAT
POINT ACROSS ALL LEVELS OF
EDUCATION THAT THERE ARE SEX AND
GENDER IMPACT ON EVERYTHING.
IN THAT EDUCATION OF SEX AND
GENDER IMPACTS AREN'T ISOLATED
TO A SINGLE CONDITION.
SO I THINK IT ACTUALLY LOOKSES
LIKE A TOTAL RESTRUCTURING OR
REFRAMING OF HEALTH
PROFESSIONALS ENCATION FROM
UNDERGRADUATE TO CONTINUING
EDUCATION.
VAST MAJORITY OF RESEARCH
CONDITIONS ESPECIALLY MEN AND
WOMEN DIDN'T REPORT BASED ON SEX
OR GENDER SO IF WE ARE GOING TO
TRY TO CHANGE OUT HEALTH
CONDITIONS ARE TAUGHT ACROSS THE
CONTINUUM OF CARE, WE CAN'T DO
IT UNLESS WE HAVE THE DATA TO BE
ABLE TO DO THAT SO IT STARTS
WITH RESEARCH IMPROVING HOW IT
ET CETERA REPORTED, MAIMING SURE
IMPACT ON WOMEN AND SEX AND
GENDER DIFFERENCES ARE REPORTED,
TAKE THAT INTO ALL LEVELS OF
EDUCATION.
>> SOMETHING KIM SAID WHICH IS
POINTING OUT HEALTHCARE FOR
WOMEN AND GIRLS DOESN'T JUST
INVOLVE REPRODUCTIVE HEALTHCARE
I KNOW I'M ON A ONE WOMAN BATTLE
AGAINST THE TERM PRECONCEPTION
CARE.
THAT IS HEALTHCARE.
WE WANT PEOPLE TO BE HEALTHY, WE
PROVIDEROID HEALTHCARE WE ARE
NOT JUST PROVIDING HEALTHCARE
BECAUSE THEY ARE -- THEY MIGHT
GET PREGNANT ONE DAY BUT PERHAPS
BECAUSE THEY ARE VALUABLE FOR
THEMSELVES.
I THINK SOMETIMES THAT GETS LOST
ESPECIALLY I WORK IN MEDICAID
FIELD BECAUSE IT OFFERS MORE
CARE TO PEOPLE DURING PREGNANCY
BECAUSE MEDICAID THRESHOLD GOES
UP IN PREGNANCY SO YOU SEE
PEOPLE ENTERING THE ED KID
PROGRAM WHEN THEY ARE PREGNANT
EVEN IN STATES WITH MEDICAID
EXPANSION BECAUSE THE THRESHOLD
IS HIGHER FOR SOMEBODY WHO IS
PREGNANT.
WE SOMETIMES GET LOST THERE.
WE ARE SAYING OH, BECAUSE WE ARE
SERVING SO MANY ADULT WHOSE ARE
PREGNANT OR WOMEN WHO ARE
PREGNANT THAT ALL WE REALLY CARE
ABOUT IS WHAT IS GOING ON BEFORE
OR BETWEEN PREGNANCY RELATED TO
PREGNANCY OPPOSED TO RELATED TO
HELP FOR THEM.
SO I WOULD LIKE TO FOLLOW-UP ON
WHAT KIM SAYS WOMEN AND GIRLS
ARE IMPORTANT WHETHER PREGNANT
OR NOT OR WHETHER THEY ARE GOING
TO GET PREGNANT OR NOT.
>> HUNDRED PERCENT AGREE.
ONE FASTEST WAY TO GET SOMETHING
IN MEDICAL EDUCATION IS
ACCREDITATION STANDARDS.
I THINK THERE ARE MANY LEVERS
HOW TO CHANGE PATIENT BUT IF I
CAN DO ONE THING HAVE IT
ACCREDITATION STANDARDS IN SOME
CLEAR WAY THAT WOULD HELP IT GET
OUT.
>> WE HAVE A QUESTION IN CHAT.
I'LL READ THIS AS FOLKS THINK
FURTHER ABOUT THE INITIAL THREE
PART QUESTION.
SEEMS WE KNOW A LOT ABOUT WHAT
WE NEED, WHAT WORKS AND WHAT
DOESN'T.
DO YOU THINK WE NEED MORE
RESEARCH AT THIS POINT?
OR SENDING RESOURCES
IMPLEMENTING EFFECTIVE
STRATEGIES?
>> SOUNDS LIKE A PROMOMENT FOR
IMPLEMENTATION SCIENCE.
>> I WOULD SAY BOTH.
I THINK YES WE HAVE A LOT OF
DATA AND RESEARCH, WE NEED MORE.
SO IMPLEMENTING STRATEGIES BASED
ON DATA WE HAVE AND ALSO HAVING
CLEAR UNDERSTANDING OF WHERE WE
NEED MORE DATA AND FOCUSING
RESEARCH DOLLARS IN THOSE AREAS.
>> DEFINITELY AGREE.
SORRY.
I COMPLETELY AGREE.
I DON'T THINK WE HAVE ALL THE
ANSWERS.
BUT THERE ARE CERTAIN EVIDENCE
BASED TOOLS THAT SUITLY WE
SHOULD BE FOCUSING ON --
ABSOLUTELY WE SHOULD BE FOCUSING
ON WIDE SCALE IMPLEMENTATION.
SORRY JENNIFER.
>> I WAS GOING TO SAY POSITION
TAKE AS RESEARCHER, PART OF THE
REASON I DO IMPLEMENTATION
SCIENCE IS IT IS A FALSE
DICHOTOMY CLEARLY YET IF I HAD
TO SAY IF I HEADACHIEST BETWEEN
TOMORROW WE WOULD DO EVERYTHING
WE KNEW WAS GOOD CARE WE DON'T
DO NOW VERSUS WHAT IS BETTER
CARE, I WOULD PROBABLY GO FOR
HELPING THE WORLD DO EVERYTHING
WE KNOW BECAUSE PART OF WHAT WE
TALK ABOUT TODAY IS WE ALL KNOW
THAT INTEGRATED CARE IS
IMPORTANT AND WE KNOW WOULDN'T
SHOULDN'T HAVE TO GO TO TEN
DIFFERENT PLACES TO GET THEIR
BASIC NEEDS MET.
WE KNOW IF PEOPLE ARE WATER
INSECURE THEY ARE PROBABLY NOT
HEALTHY AND YET HOW TO MAKE THAT
HAPPEN IS ACTUALLY HARD.
I AM A RESEARCHER, I BELIEVE IT
DOES THINGS BUT MORE AND MORE
INTERESTED MANY THE QUESTION OF
HOW DO YOU GET POLICY AND
SYSTEMS TO DO WHAT WE KNOW
CONTRIBUTES TO GOOD HEALTH.
>> JENNIFER YOU ARE SEEING
SOMETHING IMPORTANT WHICH IS
DISRUPTIVE INNOVATION IS
DISRUPTIVE.
PEOPLE DON'T LIKE THAT.
THEY LIKE WHAT THEY ARE
COMFORTABLE WITH, THEY LIKE THE
SYSTEMS THEY HAVE, ONE THING I
SEE A LOT WITH THE CARE
COORDINATION MODEL FOR MATERNITY
CARE GOING BACK TO PREGNANCY
CARE BUT WE KNOW WHAT WORKS
WE'LL NEED TO DO IT AGAIN, THERE
IS A LOT OF CONFIRMATION BIAS
PEOPLE USE CONTROL GROUPS THAT
ARE INAPPROPRIATE.
WE'LL USE THE ROLL CONTROL GROUP
PEOPLE WHO DIDN'T ENROLL IN
INTERVENTION OR REFUSED IT.
THEN WILL PROMOTE OUTCOMES BEING
LEGITIMATE THEY WOULDN'T EXCEPT
IF ON SOMETHING ELSE.
BUT BECAUSE IT IS SOMETHING THEY
LIKE THEY WANT TO KEEP IT THE
THING AROUND CARE COORDINATION
IT ISN'T DISRUPTIVE YOU HIRE
SOMEBODY THEY TAKE CARE OF YOUR
PROBLEMS, WHATEVER GOES ON IS IN
THEIR LITTLE REALM YOU KEEP
PRACTICING THE WAY YOU WANT TO
PRACTICE.
AND FEEL LIKE YOU ARE DOING
SOMETHING.
I FEEL LIKE THAT IS ONE OF MY
FRUSTRATIONS AROUND THIS IS HOW
DO YOU GET THESE POWERFUL
INTEREST GROUPS TO SAY ACTUALLY
THEY NEED TO DO THINGS
DIFFERENTLY, OR WE NEED TO
ACCEPT WE NEED TO DO THINGS
DIFFERENTLY.
>> I WOULD SUGGEST THINKING THE
REALLY BIG PICTURE MAKES SENSE
IN TERMS OF HAVING METRICS HOW
WELL WE ARE DOING.
AND JUST AS A SIMPLE EXAMPLE, I
WOULD SUGGEST PREVALENCE OF
VARIOUS RISKS AND CONDITIONS.
THE PROPORTION OF PEOPLE WHO ARE
AT RISK WHO ARE RECEIVING
SERVICES, AND THE EFFICACY OF
THOSE SERVICES.
IF WE LOOK AT THOSE OVER TIME
AND EXAMINE HOW WE ARE DOING
WE'LL HAVE A BETTER SENSE OF GEE
DO WE KNOW EVERYTHING THAT WE
NEED TO KNOW AND WE JUST NEED TO
DO MORE OF IT OR DO WE NEED TO
KNOW MORE?
MY SUSPICION IS ALL THOSE LINES
REALLY IMPORTANT LINES ARE LOT
FLATTER HAHN WE WOULD LIKE THEM
TO BE.
IT IS NOT JUST A MATTER OF
NEEDING TO TO MORE WHAT WE HAVE.
WE NEED TO KNOW MORE ABOUT HOW
TO DO BETTER.
I AGREE WITH THAT.
YOU TALK ABOUT DISRUPTED
INNOVATION.
TO GO COMPLETELY OUT ON A LIMB
THERE ARE HEALTH STUDIES THAT
SHOW RANDOMIZE TRIALS IN OTHER
COUNTRIES THAT SHOW PROVIDING
PEOPLE WITH MINIMUM INCOME
IMPROVE HEALTH OF THEM AND THEIR
FAMILIES, LONG MATERNITY, EVEN
THINGS HERE THAT WOULD BE SUCH
-- INCARCERATING PEOPLE TO THE
RATE WE DO IS NOT GOOD FOR
HEALTH OR SAFETY AND YET POLICY
WHERE PEOPLE WERE EMOTIONAL,
PEOPLE IS NOT RATIONAL AND SOME
OF THESE THINGS THE DATA IS
THERE AND POLICY AND PRACTICE
DOESN'T FOLLOW THE DATA SO HOW
DO WE GET THERE TO DO WHAT WE
KNOW NOW.
>> SO WE HAVE A FOLLOW-UP
QUESTION TO THE FIRST WHICH IS
WHERE SHOULD WE FOCUS OUR
RESEARCH?
I MIGHT ADD WHAT STEVEN SAID,
DR. TEMKIN RAISED YESTERDAY
THINKING RESEARCH GAPS AND THE
SILOS THAT WE ARE IN NOW, AND AS
PART OF THE PURPOSE OF THIS
WORKSHOP IS TO THINK ABOUT HOW
TO GET OUT OF THOSE SILOS.
AND WORK ACROSS DISCIPLINES,
WORK ACROSS HEALTH CONDITIONS
AND UNDERSTAND PREVALENCE AND
RISKMENT PART OF THE PROBLEM AS
DR. THEM KY MENTIONED YESTERDAY,
WE DON' DON'T HAVE CHRONIC CONDITIONS
AND WHAT PEOPLE'S
MULTI-MORBIDITIES ARE AND YOU AS
PRACTICERS AND RESEARCHERS ARE
ONES THAT HAVE THAT DATA.
SO MAYBE PART OF THE ANSWER TO
THAT QUESTION IS HOW TO THINK
ABOUT BREAKING DOWN THOSE SILOS
AND SORT OF ADDRESSING THOSE
GAPS WE HAVE IN RESEARCH OF THAT
INTERSEXUALITY BETWEEN HEALTH
CONDITIONS IN WOMEN AND GIRLS.
I THINK PART OF THAT WAS
MENTIONED PREVIOUSLY YES WE NEED
TO KNOW MORE ABOUT PREVALENCE OF
CONDITIONS, WE NEED TO KNOW
ABOUT SEX AND GENDER BASED
DIFFERENCES AND PREVALENCE BUT
WE NEED TO GO BEYOND THAT AND I
THINK THAT IS THE NEXT PHASE OF
RESEARCH IN MANY AREAS, NOT JUST
THE WHAT AND WHOM BUT WHY.
AS I MENTION IN MY TALK
YESTERDAY OSTEOARTHRITIS OF THE
KNEE PEOPLE DIDN'T DO AS WELL AS
MEN, WHAT WAS KNEE JERK RESPONSE
WE DESIGN FOR WOMEN,
INTERESTINGLY ENOUGH THAT DIDN'T
WORK.
DIDN'T WORK BECAUSE NOBODY AT
THAT POINT EXPLORED THE WHY.
WHEN YOU GET TO THE WHY YOU FIND
THAT THE WHY IS MUCH, MUCH MORE
CHALLENGING AND MUCH MORE
DIFFICULT TO PIECE OUT BECAUSE
THAT DOES GET INTO THE
INTERSEXUALITY OF THE PATIENT AS
WELL AS THE CONVERGENCE OF
MULTITUDE OF OTHER HEALTH
CONDITIONS.
SO AS WE LOOK -- YES LOOKING AT
PREVALENCE FOR THE CONDITIONS
FOR WHICH WE DON'T KNOW IF THERE
IS A DIFFERENCE BECAUSE WE
HAVEN'T LOOKED BUT FOR THOSE WE
KNOW THERE IS, WE NEED TO BE
LOOKING MUCH MORE SPECIFICALLY
AT WHY BECAUSE UNLESS WE
UNDERSTAND THE WHY WE ARE NOT
GOING TO KNOW EITHER A HOW TO
TREAT IT BETTER OR IDEALLY HOW
TO LOOK AT PREVENTION
INITIATIVES FURTHER UPSTREAM.
WHY INVARIABLY GETS US INTO
IMPACT CROSS CUTTING IMPACT OF
OTHER HEALTH CONDITIONS AND
IDEALLY THAT WOULD HELP START TO
BREAK DOWN SOME OF THE SILOS.
>> VERY GOOD QUESTION FOR OUR
NIH FOLKS DOES NIH INSTITUTE
FUNDING ANNOUNCEMENTS IN THIS
AREA, TO PROMOTE EXPLORING
(INAUDIBLE)?
>> THERE HAVE BEEN SOME ANNOUNCE
PES OVER THE LAST COUPLE OF
YEARS REGARDING CHRONIC
CONDITIONS AND MULTI-MORBIDITY,
THAT IS A DIRECTION THE NIH IS
RECOGNIZING AS IMPORTANT AND YOU
CAN SEE MULTIPLE INSTITUTES HAVE
SIGNED ON TO THOSE INITIATIVES.
THAT'S PART OF WHAT WE ARE
TRYING TO DO HERE AS PARTNERSHIP
IS TO THINK ABOUT THIS WITH MORE
NARROW LENS, WOMEN AN GIRLS FROM
HISTORICALLY MARGINALIZED GROUPS
THAT ARE MEDICALLY UNDERSERVED
IN ORDER TO MAKE AN IMPACT IN
COMMUNITY THAT IS REALLY NEEDS
IT.
YOU WILL SEE THAT THOSE
ANNOUNCEMENTS HAVE COME OUT AND
MORE PROBABLY FUTURE, I THINK
COMPOUNDED BY THE FACT THAT WE
REALIZED THE HUGE DISPARITIES
THAT HAVE EXISTED FROM THE COVID
PANDEMIC.
IT IS SHED LIGHT ON THAT AND YOU
KNOW THAT THE NIH HAS PUT A LENS
ON THAT BY CREATING SPECIFIC
PROGRAMS TO ADDRESS THOSE
DISPARITIES SO I THINK AS WE
COMMIT OUR FOCUS AWAY HOPEFULLY
FROM COVID WE WILL START TO
THINK ABOUT THESE OTHER
DISPARITIES IN A MORE GRANULAR
WAY.
>> I HAVE A COMMENT.
I THINK PART OF IT, THIS IS WHY
THIS MEETING IS SO IMPORTANT, WE
HAVE AN NIH DISEASE FOCUSED SO
WHEN WE REALLY TRY AND SAY
LISTEN, WE NEED TO MOVE BEYOND
SINGLE DISEASE TO HOW THESE
INTERACT BECAUSE THEY DO
INTERACT, SO IT IS HARD BECAUSE
I THINK WITH MY RESEARCH HAT ON,
YOU THINK GOSH I'M APPLYING TO
NIAAA, I BETTER JUST TALK ABOUT
ALCOHOL THOUGH I KNOW MANY
INDIVIDUALS HAVE CO-OCCURRING
OTHER SUBSTANCE USE MENTAL
HEALTH DISORDER, DIABETES,
HYPERTENSION SO IT'S BREAKING
DOWN THOSE SILOS, I THINK IS
GOING TO NEED TO OCCUR LIKE
AMONG CLINICIANS, AMONG SORT OF
HOSPITAL SYSTEMS, BUT ALSO EVEN
MORE BROADLY AMONG FUNDING
AGENCIES.
>> INTERNALLY WE TEND TO BE
BETTER WHEN WE THINK ABOUT
WOMEN'S HEALTH BECAUSE AS DR.
CLAYTON POINTED OUT YESTERDAY IN
HER EKG CHART WE KNOW WHERE
THESE CRITICAL TIME POINT ARE,
ACROSS LIFE SPAN FOR WOMEN AND
GIRLS AND ALL THESE DIFFERENT
CONDITIONS THAT AFFECT THE LIFE
COURSE ARE TRAJECTORY FOR HEALTH
AND THEN CHRONIC DISEASE SO WE
DO PRETTY GOOD WITH THOSE TYPES
OF PARTNERSHIPS INTERNALLY AT
THE NIH, WE HAVE INFRASTRUCTURE
LARGE TRANS-NIH HEALTH WORKING
GROUPS.
SO WE RECOGNIZE THAT, BUT
GETTING MOMENTUM TO MAKE NEW
INITIATIVES, IS SOMETHING THAT
DOES TAKE TIME.
THAT IS WHY WE CONVENE THIS
WORKSHOP TO HEAR FROM YOU AND
COMMUNITY STAKEHOLDERS.
>> I APPRECIATE THAT.
I WAS THINKING ABOUT THAT.
IN MY TRAINING HOW WAS IT
TRAIND? PICK YOUR INSTITUTE,
THAT WAS LONG TIME AGO.
ANY OTHER QUESTIONS AND
COMMENTS?
>> THINKING ABOUT HOW ONE OF THE
THINGS I HAVE BEEN THINKING
GIVEN ALL THIS ARE THERE
SOLUTIONS THAT CUT ACROSS MANY
OF THESE DIFFERENT CONDITIONS.
I WAS HAVE YOU BEEN BY THE
HEALTH IT TALK AND IT WAS MY
UNDERSTANDING THAT USING A
SINGLE IDENTIFIER FOR PEOPLE TO
COORDINATE HEALTH RECORDS ACROSS
SYSTEMS, IT IS SINGLE IDENTIFIER
ISSUE, IT IS ILLEGAL IN THE U.S.
BUT THAT IT IS ILLEGAL TO CREATE
A NUMBER YOU CAN USE TO LINK
HEALTH RECORDS ACROSS DIFFERENT
HEALTH SYSTEMS WITHIN THE US.
IS THAT TRUE?
>> I WOULD SAY THAT IS TRUE TISS
POINT IN TIME.
>> SO THAT IS ANOTHER FEEL LIKE
I'M HARPING ON THIS BUT IT IS
ANOTHER POLICY BARRIER BECAUSE
THAT SOLVES MANY OF THE PROBLEMS
WE ARE TALKING ABOUT IF WE COULD
ACTUALLY SHARE RECORDS BUT WE
CAN'T.
A LOT OF HEALTH SYSTEMS, CROSS
CUTTING THEMES ARE SYSTEMS
STRUGGLE WITH RESOURCES TO DO
WHAT THEY NEED TO DO, RESOURCES
TO COORDINATE ACROSS SYSTEMS ARE
SOMETIMES THEY CAN DO THEM BUT
CARE COORDINATORS PROGRAM NOT
INTEGRATEDED FROM PAYER AND SOME
OF THE THINGS TO INTEGRATE CARE
ARE IN THIS CASE NOT EVEN LEGAL.
SO SORT OF FUNDAMENTAL PROBLEM
WITH THE STRUCTURE OF THE HEALTH
SYSTEM.
>> YEAH.
SO WHILE THAT IS ONE DIRECTION
WE CANNOT TAKE WE ARE SCORING
OPPORTUNITIES FOR LOOKING AT
PATIENT MATCHING.
AND I THINK THAT QUESTION IS
SPECIFICALLY FROM YOU, JENNIFER.
I CAN SHARE RESOURCES, IF YOU
ARE INTERESTED IN SEEING THE
WORK WE HAVE BEEN DOING IN THAT
SPACE BECAUSE WE DO HAVE GROUP
OF PEOPLE DEDICATED TO FOCUSING
ON PATIENT MATCHING.
BECAUSE IT IS ONE OF THE ISSUES
THAT WE HAVE IN SEVERAL OF THE
PROGRAMS WE DO AS WELL.
>> MAY I ASK A QUESTION, WE ARE
CURIOUS IF OTHER PANELISTS AT
THE END OF THE DAY LIKE GIVEN
EVERYTHING WE HEARD IF YOU HAD A
WISH OR ONE THING YOU CAN DO TO
FIX HEALTHCARE FOR WOMEN AND
GIRLS WHAT WOULD IT BE?
>> I WILL START.
MINE IS LESS SOPHISTICATED THAN
MANY ON THE PANEL I HAVE LONG
HELD THE BELIEF IN MEDICINE, I
AM SPEAKING FROM THAT
PERSPECTIVE THIS EXPECTATION
INDIVIDUALS COME TO US AND WE
ARE SO STUCK IN THIS MODEL THAT
YOU HAVE TO COME TO CLINIC AND
TO THE HOSPITAL AND I THINK
REALLY STARTING TO THINK A
LITTLE BIT MORE ABOUT HOW WE
BRING OUR SERVICES INTO THE
COMMUNITY.
I KNOW FOLKS ARE DOING THIS,
THERE'S MORE AND MORE VAN BASED
CARE FOR INDIVIDUALS WITH
SUBSTANCE USE DISORDERS, WHETHER
DOING WOUND CARE AND SYRINGE
EXCHANGE AND SUCKS OXONE.
-- SUB OX SEWN.
IF WE CAN DO THAT MORE BROADLY
AND THINK OUTSIDE OF THE HASSLE
BUILDING AND CLINIC BUILDING, I
THINK WE'LL INCREASE ACCESS TO
CARE AND CHIP AWAY AT
DISPARITIES.
SO MANY TRANSPORTATION BARRIERS,
BARRIERS FOR PEOPLE TO GET AT
LEAST HERE IN BALTIMORE PEOPLE
TAKE THREE OR FOUR BUSES, AND
THE BUSS ARE NEVER ON TIME AND
IF IT IS RAINING OR SNOWING.
I FEEL LIKE IF WE CAN FIGURE OUT
A WAY TO MOVE A LITTLE BIT OUT
OF THE HEALTHCARE SYSTEM IN TO
THE COMMUNITY AND THEN FOCUS ON
INTEGRATING IN THE -- IN
CREATIVELY IN THAT WAY.
>> I WILL SAY EVERY IRB MEMBER
IN THE COUNTRY UNDERSTANDS SEX
AND GENDER DIFFERENCES AND THAT
ANY PROPOSAL THAT IS BROUGHT
BEFORE THEM THAT DOESN'T INCLUDE
DISCUSSION OF SEX GENDER EITHER
SENT BACK TO RESEARCHERS OR
RESEARCHERS EXPLAIN WHY SEX
GENDER IS NOT INCLUDED, I WOULD
INCLUDE THAT FOR IAKUK MEMBERS
FOR ANIMAL STUDIES.
EVERY JOURNAL IN THE COUNTRY
SIMILAR GUIDELINES, WILL NOT
PUBLISH ANYTHING THAT DOES NOT
DESCRIBE SEX GENDER DIFFERENCES
UNLESS AS STATED IN THE SAFER
GUIDELINES THE AUTHORS DESCRIBE
WHY SEX GENDER IS NOT RELEVANT
TO THEIR STUDY.
>> I'M LOVING THESE WISHES,
OTHER WISHES.
>> I FEEL LIKE WHAT WE ARE
TALKING ABOUT IS RELATED TO
POVERTY AND INSTITUTIONALIZED
RACISM SO THAT YOU SEE ALL THESE
CARE DOUBTS AND CARE PROBLEMS
AND PROBLEMS GETTING TO
APPOINTMENTS AND PROBLEM
SETTING, IN A FOOD AND SO ON, SO
FORTH IS NOT LIMITED ONLY TO BY
INCOME BECAUSE SOMETIMES THERE
ARE OTHER MENTAL HEALTH
RESOURCES MIGHT NOT BE WIDELY
AVAILABLE IN COMMUNITY NO MATTER
HOW MUCH MONEY YOU HAVE.
A LOT OF THIS IS WE HAVE SILOED
SYSTEMS IN GENERAL, AND OFTEN WE
PUT A LOT OF RESPONSIBILITY ON
SCHOOLS FOR SOLVING ALL THE
WORLD PROBLEMS AND I FELT LIKE
JUST AS WE SILOED ELEMENTS
WITHIN MEDICAL CARE, OR SILOED
ELEMENTS WITHIN DISEASE STUDY,
WE JUST HAVE -- WE TEND TO SEE
PEOPLE IN THESE RIGID SILOS AS
WELL, THIS IS YOUR EDUCATION
PART, HEALTH PART, AS OPPOSED TO
FACT THE WHOLE PERSON
EXPERIENCESES ALL THESE THINGS
AND IF YOU ARE ONLY ADDRESSING
THEM IN THESE VARIOUS COMPONENTS
COMPONENTS, YOU ARE NOT ABLE TO
HELP THAT PERSON IN THE WAY YOU
MIGHT LIKE.
I DON'T KNOW HOW WE SOLVE; THAT
IS A BIG PROBLEM SOLVING THING,
ADDRESSING POVERTY, SYSTEMIC
RACISM, WE DO HAVE THESE
SYSTEMIC ISSUES AND THE BAND AID
APPROACH SHARD.
IT IS HARD TO STOP A GIGANTIC
PROBLEM WITH A SMALL SOLUTION.
NO MATTER HOW EFFECTIVE THAT
SOLUTION MIGHT BE FOR THE LITTLE
PART OF THE PROBLEM SOLVING.
>> STEVE OR SHERRY OR OTHERS?
>> THERE IS A SMALL PART OF THE
PUZZLE IS INCREASING THE
REPRESENTATION OF RACIAL ETHNIC
MINORITIES IN THE WORK SHORES.
MY WISH IS MAJOR RESERGE
INITIATIVES GOING FORWARD BE
MINDFUL OF THAT ENHANCED SOME
COMPONENT THAT INCREASINGS
EDUCATION AND TRAINING.
FOR RACIAL ETHNIC MINORITY
CANDIDATES FOR HEALTHCARE
PROFESSIONS.
>> I THINK I WOULD ONLY ADD
JENNIFER SOMETHING MUCH SMALLER
AND MORE FOCUSED IN THE GREAT
IDEAS WE HEARD FROM OTHER
PANELISTS, THERE IS A TREMENDOUS
NEED IF NOT FOR SINGLE PAYER
HEALTHCARE WHICH I WILL JUST
STOP WISHING FOR FOR THE MOMENT
BUT AT LEAST DRAMATIC
SIMPLIFICATION OF BILLING.
AND CONSISTENCY OF PAYMENT,
EXTRAORDINARILY DIFFICULT TO
FIGURE THAT OUT TO GET PAID FOR
SOME OF THE WORK THAT WE ARE
TALKING ABOUT THAT WE KNOW CAN
IMPROVE HEALTH LIKE CASE
MANAGEMENT, LIKE BRIEF
INTERVENTIONS, LIKE COUNSELING,
LIKE INTEGRATED CARE.
IT IS JUST A GREAT BIG
CONVOLUTED COMPLICATED MESS THAT
PROVIDERS ON THE GROUND DON'T
HAVE CAPACITY OR TIME TO DIG
INTO.
SO THAT THEY GET REIMBURSEMENTS
THEY NEED, SO SIMPLIFICATION IN
THAT REGARD ALSO HELPS.
>> I WOULD ADD BASED ON WHAT I
SAID YESTERDAY, AS TO BETTER
FUND PREVENTION BECAUSE OUR
BILLING SYSTEM IS COMPLETELY
MESSED UP.
OTHER --
>> THESE JAWANNA HENRY, I WANT
TO CLARIFY WHAT I SAID EARLIER
ABOUT UNIQUE PATIENT IDENTIFIER.
IS NOT TECHNICALLY LEGAL, BUT WE
ARE PROHIBITED FROM USING HHS
FUNDS TO CREATE A NATIONAL
UNIQUE PATIENT IDENTIFIER.
SO THAT IS FOR YOUR AWARENESS,
IF I DID HAVE ONE THING IS THAT
PEOPLE WOULD BECOME MORE AWARE
OF OUR STANDARDS AND HOW THEY
CAN USE THOSE STANDARDS TO GET
THE DATA THAT THEY NEED IN ORDER
TO ENHANCE RESEARCH SO YOU CAN
HAVE THE DATA TO FIND OUTCOMES
SO WE CAN IMPROVE PATIENT
OUTCOMES.
>> IN ADDITION TO THE BIG THING
I OFTEN THINK OF LIKE I DON'T
KNOW IF I HAVE THIS RIGHT INCAR
RATE HALF THE PEOPLE --
INCARCERATE HALF THE PEOPLE,
MENTAL HEALTH BUT AGREE THAT HAS
TO DO WITH POVERTY AND RACISM
AND ALL THESE THINGS, I GUESS I
WISH ALSO THAT SOME OF THESE
ISSUES THAT TO ME IS A MECHANIC
PROVIDER ARE RESEARCHERS HEALTH
ISSUE WEREN'T SUCH POLITICAL HOT
BUTTON TOPICS.
TALKING CENTRALIZED HEALTHCARE
AND GOVERNMENT ROLE IN OUR LIVES
AND I WISH I GUESS THAT POLICY
AND LAW FOLLOWED THE DATA ABOUT
WHAT WE KNOW.
>> I WAS GOING TO ADDRESS MARRAH
HAD PUT A QUESTION IN THE CHAT
THAT SAYS I WONDER IF THERE ARE
LESSONS LEARNED FROM COMMUNITY
INTERVENTIONS FOR COVID TESTING
AND THAT SEEMS APPLIED TO WOMEN
HEALTH INTERVENTION AND JUST THE
OBVIOUS THOUGHT THAT CAME TO ME
THAT WHAT HAS BEEN HELPFUL AT
LEAST PARTIALLY IS THAT VACCINES
AT LEAST ARE FREE, YOU DON'T
NEED HEALTH INSURANCE THERE HAVE
BEEN EFFORTS TO GET THEM TO
PEOPLE POP UP VACCINE CLINICS.
AT BARS OR OTHER PLACES THAT
BRING THEM TO PEOPLE.
SO I THINK THOSE LESSONS COULD
BE CERTAINLY APPLIED TO WOMEN'S
HEALTH.
I WOULD ADD THE NUMEROUS EFFORTS
TO TRYING TO BUILD TRUST IN THE
COMMUNITY, THAT HAVE OCCURRED
THROUGH VACCINE EFFORTS WHICH I
THINK REALLY I MEAN I HAVEN'T
SEEN AS MUCH OF UNTIL THERE'S
ISSUE OF ADDRESSING HEAD ON
ISSUES OF TRUST.
>> ALSO MISINFORMATION.
I THINK WE ARE STILL TRYING TO
GET OUR HAND -- ARMS AROUND THAT
TO THE EXTEND TO WHICH IT HAS
BEEN SO SALIENT WITH COVID BUT I
THINK IT IS PROMPTING A LOT OF
MORE INNOVATIVE THINKING ABOUT
WHAT DO YOU DO WITH
MISINFORMATION AND HOW DO YOU
HELP PEOPLE UNDERSTAND WHAT IS
TRUE.
>> (INAUDIBLE) HAS LAID THERE,
THAT CRISIS AND COMMUNICATION, A
GAP IN COMMUNICATION, I HOPE WE
WILL LEARN FROM IT THAT WE
REALLY NEED TO INSTITUTIONALIZE
THE COMMUNICATION, METHODS FOR
COMMUNICATION BETWEEN RESEARCH
ENTERPRISE, THE PRACTICE
ENTERPRISE AND COMMUNITIES.
SO THAT IT IS NOT WHEN SOMETHING
LIKE THIS HAPPENS AGAIN, IT
WILL, CRISIS THOSE MECHANISMS
ARE IN PLACE.
AND WE HAVE BRIDGED THE GAP.
OR AT LEAST COME CLOSER TO
BRIDGING THE GAP, THE
COMMUNICATION GAP THAN WE ARE
RIGHT NOW.
>> I THINK ON MY WISH LIST I
WOULD PUT AT THE TOP HEALTH
EQUITY.
AND FROM THAT WILL FLOW MANY
DIFFERENT INSTITUTIONAL CHANGES
AND SCALE UP AND I REALLY LIKED
WHAT WAS SAID ABOUT DISRUPTIVE
TECHNOLOGIES.
SO I THINK IF WE USE THE
FRAMEWORK OF DISRUPTIVE
TECHNOLOGIES TO REFRAME HEALTH
EQUITY TO ADDRESS
MULTI-MORBIDITY IN WOMEN AN
GIRLS WE WILL REALLY COME UP
WITH A STRATEGY THAT WILL BE
VERY EFFECTIVE FOR US.
THEN I THINK THE OTHER THING, I
ALWAYS THINK ABOUT WHO IS NOT IN
THE ROOM.
IT IS WOMEN -- THE WOMAN
HERSELF. THE WOMAN WHO IS
LIVING THE COMPLEX COMPLICATED
LIFE THE USE OF LANGUAGE REFER
TO THE WOMAN AS PREGNANCY AS
OPPOSED TO A WOMAN.
AND I THINK THOSE WILL BE
INSIGHTFUL STRATEGIES.
>> ANY FINAL THOUGHTS?
WELL, I AM -- JUST ON BEHALF OF
THE WHOLE COMMITTEE AND JENNIFER
REALLY WANT TO THANK EVERYONE
FOR ATTENDING AND FOR REALLY
THIS ROBUST DISCUSSION AT THE
END OF ALL THE SESSIONS, I THINK
IT HAS BEEN OUTSTANDING.
AND I LOOK FORWARD TO SEEING
WHAT IS GOING TO COME.
>> THANK YOU ALL FOR THE
WONDERFUL IMPRESSIVE WORK YOU
ARE DOING AND FOR THE TIME TO
TELL US ABOUT IT AND THINK ABOUT
IT SO WE CAN GET TOGETHER AND
THINK ABOUT WHAT ARE THE CROSS
CUTTING THEMES AND HOW CAN WE
LEARN FROM EACH OTHER MAKE IT
ALL THE WHOLE SYSTEM WORK
BETTER.
>> THANK YOU BOTH.
FOR CO-CHAIRING THIS WORKSHOP,
WE APPRECIATE ALL YOUR INSIGHTS
AS WELL.
DEIDRA DID YOU WANT TO SAY
SOMETHING?
>> JUST ECHOING THANKS TO
CO-CHAIRS AND TO ALL OF OUR
PANELISTS FOR VERY INFORMATIVE
AND INSPIRING PRESENTATIONS.
I REALLY HAVE LEARNED A LOT FROM
THIS WORKSHOP AND MY FONDEST
DREAM IS TO KEEP THE
CONVERSATION GOING OVER THE
WEEKS AND MONTHS AHEAD TOWARDS
SOME ACTION.
MEANINGFUL ACTION.
>> YEAH.
LOGISTICALLY I WANT TO REMIND
ATTENDEES THAT ARE WITH US THAT
YOU DID DISTRIBUTE THE PROGRAM
BOOK WHICH WILL HAVE CONTACT
INFORMATION FOR THE SPEAKERS IF
YOU DECIDE TO FOLLOW-UP WITH
THEM DIRECTLY.
ALSO HAS OUR CONTACT INFORMATION
AT THE NIH IF YOU HAVE QUESTIONS
FOR US SPECIFICALLY TO DEIDRE'S
POINT WE WANT TO KEEP THE
CONVERSATION OPEN, THIS IS THE
FIRST STEP IN TRYING TO ADDRESS
MULTIMORBIDITIES, WE OF COURTS
UNCOVERED ALL CONDITIONS RELATED
TO WOMEN HEALTH.
WE HIGHLIGHTED A FEW COMMON
CO-OCCURRING CONDITIONS SO WE
WANT TO HEAR ABOUT OTHER
IMPORTANT CONDITIONS THAT HAVE
HIGH IMPACT FOR WOMEN AND
MULTI-MORBIDITY AND IN THEIR
LIVES SO OUR EMAILS ARE THERE
AND YOU CAN CONTACT US AT ANY
TIME.
THEN ALSO BOTH DAYS OF THIS
WORKSHOP WILL BE ARCHIVED ON THE
NIH VIDEOCAST.
SO YOU ARE WELCOME TO REVIEW THE
PRESENTATIONS OR SHARE WITH
COLLEAGUES WHO WEREN'T ABLE TO
MAKE THE MEETING THE LAST TWO
DAYS.
AND WITH THAT I WANT TO THANK
EVERYONE AGAIN FOR SUCH ENGAGING
WORKSHOP AND LOOK FORWARD TO
WORKING WITH ALL OF YOU AGAIN.
THANK YOU.