Chapters authored
Beautiful Ruin: Creating Healthfields By Laurel Berman
Multiple programs promote redevelopment of land reuse sites, which are environmentally impacted or potentially contaminated sites. Historically, such programs have focused primarily on economic development. However, public health is an important consideration to address not only sustainable redevelopment but also health inequity and disparities. The Agency for Toxic Substances and Disease Registry’s (ATSDR) Land Reuse Health Program is a special program to promote broad public health improvements through safe land reuse and redevelopment. Land reuse sites are virtually in every community in the U.S. and are a global problem. Brownfields are the greatest number of land reuse sites. With estimates of over 450,000 land reuse sites across the U.S., most communities suffer the burden of blight and contamination associated with these sites. ATSDR promotes and practices Healthfields Redevelopment: The safe reuse of environmentally distressed land to reduce exposures to contaminants and to improve overall health in the community. In this chapter, I highlight Navajo Nation Healthfields activities using ATSDR’s 5-step Land Reuse Strategy to Safely Reuse Land and Improve Health (5-step Land Reuse Model) and describe some of ATSDR’s Healthfields projects and related tools and resources for communities to create their own Healthfields practice.
Part of the book: Leading Community Based Changes in the Culture of Health in the US
Violence: A Prescription of Hope for a Vulnerable Population By Tonita Smith, Edith Amponsah and Lia Garman
Violence is a preventable disease that has long term effects on health. In the United States, violence has become an epidemic that disproportionately affects the African American community. Risk factors that contribute to the perpetration of youth violence include a combination of individual, relationship, community, and societal factors. Individual risk factors include a personal history of victimization of violence, high emotional stress, and exposure to violence and conflict. Family risk factors include low parental education, low income, poor family functioning and low parental involvement. Community risk factors include diminished economic opportunities, high concentration of poor residents, and socially disorganized neighborhoods – all of which are prevalent in communities with high rates of violence. Preventive strategies aimed at reducing violence need to be collaborative and community based. This multi-city project, A Prescription of Hope, aims to educate community members from Illinois and Missouri on the long- term effects of exposure to violence. The target population for Missouri is Ferguson, a small community with an approximate population of 21,035 (2017); however, it is recognized nationally for the demonstrations and unrest that erupted after the August 9, 2014 shooting death of 18-year-old Michael Brown. Worldwide, an estimated 200,000 homicides occur each year among youth aged 10–29 years, accounting for 43% of all homicide annually.
Part of the book: Leading Community Based Changes in the Culture of Health in the US
Building a Dental Home Network for Children with Special Health Care Needs By Mark DeRuiter, Jeffrey Karp and Peter Scal
Children with special health care needs (SHCNs) live in all communities. They present with a diverse group of diagnoses including complex chronic conditions and diseases; physical, developmental, and intellectual disabilities; sensory, behavioral, emotional, psychiatric, and social disorders; cleft and craniofacial congenital disabilities, anomalies, and syndromes; and inherited conditions causing abnormal growth, development, and health of the oral tissues, the teeth, the jaws, and the craniofacial skeleton. Tooth decay, gum disease, dental injuries, tooth misalignment, oral infections, and other oral abnormalities are commonly seen or reported in the health history of children with SHCNs. Nationally, dental and oral health care ranks as the second most common unmet health need, according to the most recent National Survey of Children with Special Health Care Needs. The State of Minnesota does not have enough dental professionals prepared to meet the demand for care. As a result, children with SHCNs either go untreated or receive inadequate services resulting in treatment delays, the need for additional appointments, poor management of oral pain and dysfunction, adverse dental treatment outcomes and/or a lack of appropriate referrals to needed specialists. Research suggests children with SHCNs are best served when assigned to dental homes where all aspects of their oral health care are delivered in a comprehensive, interdisciplinary, and family-centered way under the direction of knowledgeable, experienced dental professionals working collaboratively with an array of allied health, medical professionals, and community partners. An interdisciplinary team consisting of a pediatric dentist, pediatric physician, and speech-language pathology innovator collaborated to advance current and future dental providers’ knowledge and comfort in providing care for children with SHCNs and was accepted into the Clinical Scholars program. Their interdisciplinary collaborative team project was named MinnieMouths and included the following six methods or critical endeavors to ensure success: 1. Development of a project ECHO site focused on advancing care for children with SHCNs. 2. Creation of a 28-participant web-based professional network of current dental, community health liaisons, family navigators, and medical health providers. 3. Establishment of a 32-participant web-based interface of dental and medical students and residents, including new-to-practice dental providers. 4. Launching an annual conference focused on advancing oral health care for children with SHCN. 5. Build a toolkit aimed at allowing dentists and future leadership teams to launch dental home networks focused on children with SHCN. 6. Building a Dental Homes Network Field Guide for Providers who attended our first in-person conference. Findings from the MinnieMouths project suggest that development of peer networks to advance dental homes for children with SHCNs has merit. Network participants gained skills in collaborating with a range of health care providers, understanding the complexities of working within and among health and dental care systems to coordinate care, and the need to better understand and advocate for a more robust medical and dental reimbursement program when launching dental homes for children with SHCN.
Part of the book: Leading Community Based Changes in the Culture of Health in the US
Creating a Culture of Mental Health in Filipino Immigrant Communities through Community Partnerships By Aviril Sepulveda, Dean M. Coffey, Jed David, Horacio Lopez, Kamil Bantol and Joyce R. Javier
One out of five children in the United States has a mental, emotional, or behavioral health diagnosis. Behavioral health issues cost America $247 billion per year and those with mental health disorders have poorer health and shorter lives. Evidence-based parenting interventions provided in childhood have proven to be effective in helping parents to prevent disruptive, oppositional and defiant behaviors, anxiety and depressive symptoms, tobacco, alcohol, and drug misuse, aggression, delinquency, and violence. Yet, few parents participate in such programs, especially hard-to-reach, underserved minority and immigrant populations. The Robert Wood Johnson Foundation has identified a culture of health action framework that mobilizes individuals, communities, and organizations in order to examine ways to improve systems of prevention, invest in building the evidence base for such systems, and provide evidence-based information to decision makers. The overarching goal of this effort was to create a culture of mental health among Filipinos, a large, yet understudied immigrant community that is affected by alarming mental health disparities, including high rates of adolescent suicide ideation and attempts. Our impact project focused on increasing the reach of the Incredible Years® because maximizing the participation of high-risk, hard-to-engage populations may be one of the most important ways to increase the population-level impact of evidence-based parenting programs. If the approach succeeded with Filipinos, comparable strategies could be used to effectively reach other underserved populations in the U.S., many of whom are reluctant to seek behavioral health services. In this chapter we discuss 1) the state of the literature on the topic of Filipino adolescent mental health disparities; 2) our wicked problem and the impact project aimed at ameliorating this issue; 3) how our team formed and implemented our impact project; 4) outcomes and results of our efforts; 5) challenges we faced and how they were overcome; 6) the leadership and health equity skills that were most helpful in addressing our problem; and 7) a toolkit that could assist other communities addressing youth mental health and prevention of suicide and depression.
Part of the book: Leading Community Based Changes in the Culture of Health in the US
Addressing the Under-Representation of African American Public Health Researchers: The Flint Youth Public Health Academy By Kent Key
In order to meet the health needs of a culturally diverse population, the United States public health workforce must become ethnically diversified to provide culturally competent care. The underrepresentation of minority, specifically African American public health professionals may be a contributing factor to the high rates of preventable health disparities in the African American community. Studies have shown that racial/ethnic communities bear the highest disparities across multiple health outcomes. African Americans, when compared with European Americans, suffer the greatest rates of health disparities, thus providing the justification to increase minority public health professionals. In addition, studies suggest that minorities are more likely to seek medical and health services from individuals of the same ethnicity. This will assist in decreasing language and comprehension barriers and increase the cultural competence of the health providers who serve populations from their ethnic/cultural origin. This chapter will highlight a 2014 study designed to explore and identify motivators for African Americans to choose public health as a career. African American public health professionals and graduate students were engaged to discuss their career and educational trajectories and motivators for career choice. Using qualitative research methods, this study was guided by the following research question: what are the motivating factors to engage African Americans into careers in public health? The study was approved by the Walden University Institutional Review Board and was conducted in 2014. The results of this study have served as the blueprint for the creation of the Flint Public Health Youth Academy (FPHYA). Coincidently the 2014 study was wrapping up at the genesis of the Flint Water Crisis (FWC). The FWC impacted residents of all ages in Flint. Specifically, the youth of Flint were exposed to lead (a neuro-toxin) and other contaminants through the water system which impacted them physically and cognitively. National media outlets disseminated headlines across the world that Flint youth would have behavioral (aggression) issues and struggle academically as a result of their exposure to lead. The FPHYA was designed to provide positive messages to and about Flint youth. It is an introduction to careers in public health, medicine, and research for Flint Youth. It creates a space for Flint youth to work through their lived experience of the FWC while learning the important role public health and research plays in recovering from an environmental public health crisis. More importantly, it is a pathway to public health careers providing didactic sessions, local mentors and internships.
Part of the book: Leading Community Based Changes in the Culture of Health in the US
Oral Health in Communities and Neighborhoods (OHICAN) Pilot Project: The Burden of Poor Oral Health By Charles E. Moore, Hope Bussenius and David Reznik
Poor oral health afflicts many low-income and other vulnerable populations. Lack of access to oral health can lead to unnecessary tooth decay, periodontal disease, pain, and the advancement of oral cancer. The absence of preventive care often leads to unnecessary and expensive visits to hospital-based emergency departments to address the pain of dental disease but not the causal conditions. The consequences on inequitable access to dental care are significant for individuals, families and communities. The OHICAN pilot project looked to address the lack of equitable access to care by creating new points of access, training medical providers to perform oral exams and apply fluoride when indicated, thus increasing the oral health workforce, utilizing technology to bridge clinical practice, education, training and research, educating stakeholders to allow dental hygienists to provide preventive care under general supervision, and creating business models that will assist others who seek to create a dental home for those they serve. Social, political and economic forces all contribute to varying degrees in terms of equity in healthcare. The work of OHICAN was designed to create a blueprint for potential solutions to these issues in order to foster oral health equity. Changes to improve access to dental care can take place in a relatively short period of time when all who care and are impacted by this continued unmet oral health need work together.
Part of the book: Leading Community Based Changes in the Culture of Health in the US
From Margins to Mainstream: Creating a Rural-Based Center of Excellence in Transgender Health for Upstate, New York By Carolyn Wolf-Gould
Transgender people face many barriers to healthcare, especially in rural America. The work to decrease barriers to care and address health care disparities for this population meets criteria for a wicked problem, each of which is unique and has no clear solution. The barriers are related to the individual and society and are both formal and informal. The definition for a Center of Excellence in healthcare is loose, but these organizations aspire to serve as specialized programs that offer comprehensive, interdisciplinary expertise and resources within a medical field to improve patient outcomes. With funding and leadership training from the Robert Wood Johnson Clinical Scholars program, a group of medical and mental health clinicians worked for three years with the goal of creating a Rural-Based Center of Excellence in Transgender Health embedded within a family practice to approach the wicked problem of transgender healthcare in their region. The goals of the center were six pronged: the provision of competent and affirming medical, surgical and mental health services, training for healthcare professional students, medical-legal advocacy and patient-centered research. The team created a strategic plan, with five strategic directions, including 1) developing infrastructure and organizational capacity, 2) expanding awareness, knowledge and skills, 3) fulfilling staffing needs, 4) ensuring gender-affirming care, and 5) advancing evidence-based care. I describe our work to bring transgender health from the margins to the mainstream for our region through implementation of this strategic plan.
Part of the book: Leading Community Based Changes in the Culture of Health in the US
The MHISTREET: Barbershop Embedded Education Initiative By Nnemdi Kamanu Elias, Alfred Larbi, Kevin Washington and Erin Athey
The United States (US) is in the midst of a mental health crisis. More than one in four (26.2%) adults experience a diagnosable mental health disorder each year, and 46% of the population will do so in their lifetime. Collectively, mental health disorders are a leading cause of disability and account for one-third of all years lived with disability and premature mortality. Black Americans constitute about 12% of the US population, but they make up more than 18% of the population affected by mental disorders. Black men are 30% more likely than non-Hispanic white men to report having a mental illness but are less likely to receive proper diagnosis and treatment. Black adults are 20% more likely to report serious psychological distress than white adults. Despite this, many Black people do not seek mental health care for various reasons. Causes of higher morbidity and non-care seeking behavior in Black people and Black men in particular include racism, discrimination, stigma, and distrust of the healthcare system. Across the District of Columbia (DC), Black Americans are twice as likely as other ethnicities to report a serious mental disorder, especially if they live in poverty and did not complete high school. In the project service area of Ward 8 in Southeast DC, 92% of the population is Black, 30.7% live in poverty, and only 85% of the population age 25+ completed high school. Evidence shows common mental health disorders are distributed according to a gradient of economic disadvantage across society; the poor and disadvantaged suffer disproportionately from common mental health disorders. In Southeast DC, this negative impact on mental health is compounded by the geographic concentration of underemployment, lack of economic opportunity, poverty, and underutilization of mental health services. Improving mental health literacy is a non-systemic intervention shown to increase mental health care-seeking behaviors. Mental health literacy is the knowledge of, attitude about, and behavior toward mental health issues and mental health services. The goal of the Mental Health Improvement through Study, Teaching, Rebranding, Embedded Education, and Technology or (MHISTREET) initiative is to improve mental health in Black men through embedded education in non-traditional spaces such as barbershops.
Part of the book: Leading Community Based Changes in the Culture of Health in the US
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