Wednesday, April 23, 2014

Adapting Race & Ethnicity Categories to Fit your Community

By Jeff Desmarais & Ranjani Paradise

In honor of National Minority Health Month, ICH is exploring the complexities of race and ethnicity data collection. Any program, organization, or institution seeking to identify and address racial and ethnic health disparities must collect race/ethnicity data on the individuals they serve. However, in practice this proves challenging, as individuals often do not identify with the racial and ethnic categories provided.

ICH partners with the Cambridge Health Alliance (CHA) Zero Disparities Committee to ensure that race and ethnicity patient data are both accurate and meaningful for patients and the hospital. We assist CHA with patient demographic data collection and analysis, which helps CHA address disparities in service utilization and ensure that all patients receive linguistically and culturally appropriate care. We collect race data by asking patients to choose one or more of the categories defined by the federal Office of Management and Budget (OMB):
·        American Indian or Alaska Native
·         Asian
·         Black or African American
·         Native Hawaiian or Other Pacific Islander
·         White
·         Other

These OMB categories are required for state and national reporting and allow us to easily compare the race distribution of our patient population with other healthcare systems’ or communities’. However, CHA’s patient population is extraordinarily diverse, and the concept of race varies widely across cultures. Many of our patients simply do not relate to the OMB race definitions and categorizations. For example, Latino patients and Middle Eastern patients often express confusion when asked to select a race, as many do not see themselves fitting any of the given categories. And while it may seem clear that patients from India should fall under the Asian category, some Indians disagree - to them, Asian indicates East Asian and is distinct from South Asian. Overall, more than 25% of CHA’s patients do not identify with any of the OMB categories and choose “Other” as their race, which calls into question the usefulness of the OMB categories in our increasingly diverse community.

Because of these issues, we also collect detailed ethnicity data to better characterize our patients’ cultural backgrounds. Patients are asked to self-identify their ethnicity (or ethnicities) from a list of more than 150 options (e.g., Algerian, Bangladeshi, Egyptian, Greek, Nepalese, Syrian, etc.). We strive to make these ethnicity options specific enough that patients can select one or more with which they truly identify. Overall, we find that ethnicity data can be far more useful than race data for ensuring we provide culturally appropriate care to everyone we serve.

ICH also works as the evaluator of the Youth First Initiative in Holyoke and Springfield, MA. Youth First is a community-wide teen pregnancy prevention initiative, which was developed with grant funding from the Centers for Disease Control and Prevention. The Initiative is a collaboration between the Massachusetts Alliance on Teen Pregnancy (MATP), the YEAH! Network, and many stakeholders within the two communities, including schools, community organizations, and health clinics. Youth First began in 2010 and its goal is to reduce teen births by 10% by 2015 in Holyoke and Springfield, MA. While the overall teen birth rates in these communities are significantly higher than the state’s, there are also large racial/ethnic disparities within the communities.

Source: Births (Vital Records). Massachusetts Community Health Information Profile (MassCHIP). Version 3.0r328. Massachusetts Department of Public Health. Data downloaded May 6, 2013

Thus, collecting meaningful race/ethnicity data is critical to both improving and documenting improvement in teen pregnancy prevention efforts.

One of the key components of the Youth First initiative is implementing evidence-based sexual health education programs for adolescents. As a part of reporting requirements for funders, we collect race/ethnicity data from program participants via surveys. Collecting this data allows us to understand the populations we are reaching. In addition to the OMB race categories, the CDC requires data for the following ethnicity categories:

·         Hispanic or Latino
·         Not Hispanic or Latino

Cultural practices, beliefs, values and behaviors, all of which can reflect a person’s identity, can have an impact on a community’s health. Collecting data that taps these identities, if done meaningfully, can serve as an indicator to better understand, explain and ultimately address health inequities. With large Spanish-speaking communities in Springfield and Holyoke, it is critical to use measures that capture their unique and specific identities. Using the race/ethnicity categories often required by funding organizations can prohibit a comprehensive understanding of how communities might view themselves. For example, a Dominican or Puerto Rican teen might not identify with any of the OMB racial categories. Additionally, using the ethnicity category “Hispanic or Latino” can mask differences within Spanish-speaking communities. A teen that grew up in rural Mexico might have very different experiences, behaviors and values than a Puerto Rican teen that grew up in Holyoke. In this project, in order to ensure identity is accurately captured, we added an additional question that includes a much more comprehensive list of 29 different ethnicity categories (for example: Puerto Rican, Caribbean Islander, Dominican, Korean), thus expanding our understanding of identity among youth enrolled in evidence-based programs.

Capturing race and ethnicity data is essential not just for program improvement purposes, but also for ensuring that public health interventions are actively addressing health inequities. In developing alternative ways of measuring this data, it is critical to engage the community during the instrument development phase. It’s often necessary to go beyond the basic race/ethnicity reporting requirements, and delve deeper into communities’ understanding of race, ethnicity, and identity, in order for the data to be meaningful and actionable. 

The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.

Wednesday, March 26, 2014

ICH Supports Community-Based Approaches to Opioid Abuse Prevention

By Lynn Ibekwe, MPH

Although opioid abuse has been a growing problem over the past decade, public awareness has only recently peaked due to opioid deaths around the country reaching epidemic proportions and the deaths of celebrities like Phillip Seymour Hoffman and Cory Monteith. Opioids are highly addictive substances that include heroin and prescription pain medication such as morphine, codeine, oxycodone, and buprenoprhine. Characterized as an “urgent public health crisis” by U.S. Attorney General Eric Holder, rates of fatal heroin overdose, opioid drug trafficking, and prescription drug misuse and abuse have sharply increased in recent years. According to Drug Administration Enforcement (DEA) officials, the growing use of heroin stems from the corresponding growth in prescription painkiller abuse. In 2010, about 12 million Americans reported using prescription painkillers for non-medical purposes in the past year. Today, four out of five adults (ages 12 and older) who recently began using heroin had previously abused painkillers.

Past Month & Past Year Heroin Use among Americans Aged 12 or Older: 2002-2012 [1]  

Massachusetts communities have not been immune to the opioid epidemic. With many New England cities and towns now reporting dramatic increases in opioid overdoses and death, communities and stakeholders across MA are mobilizing to address this growing problem. ICH has been engaged in a number of these efforts over the past few years, including the current Massachusetts Opioid Abuse Prevention Collaborative (MOAPC) and the Partnerships for Success II (PFS II) initiatives.

MOAPC is a 
Massachusetts Department of Public Health Bureau of Substance Abuse Services (BSAS) funded project that aims to increase both the number and the capacity of communities across Massachusetts addressing opioid misuse and abuse. ICH works with the MOAPC Cambridge cluster, consisting of Cambridge, Everett, Somerville, and Watertown and lead by the Cambridge Public Health Department (CPHD). The mission of this collaborative is to employ systems-level approaches to prevent opioid misuse and reduce unintentional deaths and hospital events associated with opioid poisonings. Cluster members are currently strategizing around activities and initiatives to address key factors associated with opioid abuse, overdose, and death in their communities, such as access to opioids, low provider knowledge around prescription drug misuse, and misconceptions around the safety of non-medical use of prescription drugs.

ICH also collaborates with the cities of Quincy and Worcester on the three-year PFS II project funded through BSAS. Impact Quincy and the City of Worcester’s Division of Public Health (WDPH) were two of the many community-based prevention programs in MA awarded PFS II dollars to address prescription drug misuse and abuse in their communities. Both organizations have spent the past year identifying a number of prevention strategies to address misuse among youth, including:
  •  Increasing the number of locations for safe disposal of prescription drugs
  • Developing mass media and educational campaigns aimed at raising awareness among parents and community members
  • Conducting trainings and professional development workshops to educate physicians and other medical providers around the non-medical use of prescription drugs (NMUPD)
  • Developing social norms/marketing campaigns and a health curriculum for youth around misperceptions of peer use and safety of NMUPD

As the local evaluator for these initiatives, ICH assists these multi-sectoral groups in identifying evidence-based strategies for opioid abuse prevention, soliciting and analyzing community input, and documenting and understanding their impact. Our participatory approach values local knowledge and encourages capacity building so that our communities are well equipped to curb this disastrous epidemic. 

[1] Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.

Tuesday, February 11, 2014

ICH Volunteer Day

By Nazmim Bhuiya

On January 17th, ICH held our inaugural Volunteer Day at Cradles to Crayons (C2C) in Brighton. C2C is dedicated to providing children from birth to age 12, living in low-income and homeless situations, with the essential items they need to thrive - at home, at school and at play. At their Giving Factory, we sorted through and checked the quality of donated clothes, shoes, books, toys, and other necessary items and put together outfits for children. Together we were able to make a difference for almost 200 children across the state!

It was a great opportunity to roll up our sleeves and volunteer at Cradles to Crayons!

“I had a great time putting together outfits for baby boys in need - this was especially fun for me as I am expecting a baby boy in just a few weeks! I was very impressed with the care that Cradles to Crayons takes to make sure that children receive high-quality items, and I would love to volunteer there again in the future.” – Ranjani Paradise, ICH Research Associate II

“This was a great opportunity to step away from my desk for one morning and take a more hands on approach to making a difference in the community. I was amazed by how quickly time passed as I created outfits for young girls, and how many children we were collectively able to impact in such a short span of time.” – Reann Gibson, ICH Research Associate I

“We had a great time at the triage station where we sorted through all the donation items. It was good to work with colleagues outside of the office and also having an opportunity to give back to our community collectively as an organization.” – Nazmim Bhuiya, ICH Research Associate II

The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.

Thursday, January 23, 2014

Data Viz and Mixed Methods: How to Make Results Compelling

By Maeve Conlin & Molly Ryan

Here at ICH, we often use a mixed methods design for our research and evaluation projects. A mixed method approach acknowledges the limitations of only using one type of data source. It involves collecting and analyzing qualitative data, typically from interviews or surveys, and quantitative data, like mortality rates.  

Using multiple data sources helps to create a more complete and compelling picture of the data’s story. Mixed methods allow us to contextualize facts and figures, grounding them in the programs, projects, and communities they summarize. Perhaps most importantly, mixed methods facilitate a strength-based analysis, allowing for an exploration of opportunities as well as challenges.

Visualization Techniques to Connect Quantitative and Qualitative Data

Mixed methods are essential for much of our work at ICH, including all of our needs assessment projects. To conduct a needs assessment, we collect and analyze both quantitative data, like mortality causes, ED visits, and hospitalizations, along with community feedback on local health needs and solutions to health challenges. The result is A LOT of data! One strategy for helping your audience draw connections between your data is to include related quantitative and qualitative data side-by-side:

This same method of showing quantitative and qualitative data together can also be used for surveys, another tool we use frequently at ICH. For example, survey participants may be asked to rate their satisfaction with a variety of topics and explain their rating in a comment section. In this case, combining quantifiable participant satisfaction data with related quotes grounds the data and presents a fuller picture:

Making Qualitative Data Compelling
Within our qualitative data, we often look for ways to visually demonstrate similarities and differences across data points. As shown below, this can be done using a table format to display key themes. However, because this approach essentially quantifies qualitative data, we also include illustrative quotes so we do not to lose the interviewees’ voices or the richness of their comments.

Table 1: High-Risk Patient Definition by Site and Type of Respondent

Tailoring Data Visualization to Meet Unique Needs
Understanding data visualization processes and techniques helps us to present data that is not only eye-catching but easily understood. We can highlight important patterns and findings within a larger data set so that stakeholders can easily draw conclusions and make decisions.

However, having new and interesting ways to display data is not enough. Here at ICH, we work with a wide array of partners, including academia, hospitals, schools and community-based organizations. Exactly how and what data is presented, and to whom, are key considerations in the data visualization process. Most stakeholders or partners likely have different data needs, and it’s important to ensure you are presenting the information in a way that is comprehensible and useful for each unique project and audience!

The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.

Tuesday, October 22, 2013

Walking in the Workplace: ICH Staff Embrace Workplace Wellness

By Kelly Washburn, MPH

At the end of July 2013, the Cambridge Health Alliance’s (CHA) Take CHArge Wellness Program hosted a 6-week walking competition for all departments at CHA. Kelly O’Connor, Program Manager of Population Health, oversees the wellness program and describes the goal of the program as follows: “by developing policies, activities and a work environment that promotes and encourages wellness, the program seeks to create a healthy, engaged workforce who are role models for our patient community, working in a health conscious and supportive culture.”

The rules of the competition were simple: form a team, elect a team captain, and record team members’ steps each week. The team with the highest average number of steps wins! The ultimate prize for the winners was chair massages for the entire team. As somebody who sits at a computer much of the day, the chair massage was enticing enough for me to form a team at ICH. Within a day, 16 ICH staff members agreed to take on the challenge. Each team member received a welcome kit containing a pedometer, brochure, and a bracelet, which said “Goal: 10,000 steps a day”.
Initially, I thought the competition would be easy: “I walk plenty each day, how hard could this competition really be?” Oh, how wrong I was. It wasn't until I strapped on a pedometer that I realized how little activity I actually do throughout the day. The team definitely needed to get proactive about increasing activity levels throughout the workday, so we made efforts to ensure we were walking whenever possible at the office.  With the Gold Star Mothers Park located right next to ICH, it was the perfect place for walking meetings or even just grabbing a coworker for a short walk to take advantage of the beautiful summer weather. At the end of the six weeks, Team ICH had a combined total of 5,978,944 steps! All the teams’ steps were tallied and the results were in….ICH came in second place.

Even though we didn't win the ultimate prize, the competition was a great venue for ICH staff to remember the importance of taking a few minutes each day to go outside, walk and be active.  Additionally, it helped promote the concept of walking meetings instead of moving from one seat to the next. Changing office culture takes time, but this competition helped remind us all that as public health professionals we must take initiative and do the same activities we promote in the community.  

The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.

Thursday, October 17, 2013

Trauma Services for Children & Families: Lessons Learned from Program Evaluation

By Molly Ryan, MPH

This month several Institute for Community Health staffers will showcase our program evaluation work at the American Evaluation Association Annual Conference. Participatory program evaluation is central to the ICH mission and is one of our core services.  In honor of AEA and National Depression Screening Day, we’re highlighting our work evaluating mental health services with the Central Massachusetts Child Trauma Center (CMCTC).

ICH has partnered with CMCTC for the past year to evaluate their delivery of evidence-based, trauma-informed mental health services for children and adolescents, particularly those with a military affiliation. ICH and CMCTC project staff utilize standardized trauma evaluation tools to measure trauma exposures and symptoms, resulting behaviors, and caregiver strain. Mental health providers administer the tools, which are then sent to ICH for immediate analysis. This immediate analysis provides mental health clinicians, patients, and families with data in “real time”, allowing providers to efficiently modify the care plan and help validate patients and families’ experiences of trauma. Our periodic aggregate review of clinical assessment data also helps the project directors understand the strengths and limitations of the treatments, informs training improvements, and ultimately contributes to the treatment models’ evidence base.

As we enter our second year of evaluation, we’re reflecting on some of the key lessons learned:

  • Just because a tool is standardized does not mean it’s easy to follow! In order to ensure data reliability, it’s important for providers to be trained users of the tools and for them to help clients complete the tools.
  • Evaluators must ensure that clinicians are comfortable using the evaluation tools in the clinical encounter.
    • Tip: Use a combination of text and graphics to explain evaluation results. This will help both providers and caregivers understand the data.

  • When using multiple data collection tools at multiple time points, help providers keep track of upcoming due dates. This is particularly important if providers have several clients enrolled in the evaluation.
    • Tip: Remind providers when a client’s follow-up assessment is approaching. Time the reminder so that clinicians have enough scheduling flexibility to complete the assessment.  Several reminders may also be necessary.
    • Tip: Create schematics like the one below to help providers understand when to complete evaluation tools.

  • It’s important to recognize that it can be difficult for vulnerable populations, such as individuals receiving trauma services, to remain in care. Unstable living situations, acute mental health problems, and readiness for treatment are just a few of the issues that our program population frequently endure. As a result, “lost to follow up” is a common issue for program evaluation.
    • Tip: Maintain open lines of communication with providers in order to track clients’ progress and create a tracking mechanism to document clients’ change in status.
    • Tip: Anticipate that clients are more likely to drop out of treatment in the first 3 months. Work with program staff to identify the information that is essential and meaningful to capture if a client has not been actively engaged in treatment.

Meaningful evaluation of mental health services depends on effective and efficient collaboration between project leaders, clinicians, and evaluators.  Our experience with this evaluation highlights the value of multi-disciplinary partnerships to improve mental health outcomes for children and their families. 

The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.

Tuesday, October 8, 2013

Emergency Preparedness in Massachusetts: Perspective of an Early Career Public Health Professional

By Lynn Ibekwe, MPH

September 2013 marked the tenth annual National Preparedness Month, sponsored by the Federal Emergency Management Agency (FEMA). In recognition of emergency preparedness as a public health issue, ICH is continuing its efforts to raise awareness about emergency preparedness.

In the wake of recent natural and man-made disasters, the term “emergency preparedness” has often been used; however, few people know exactly what it entails, especially as it pertains to health and medical preparedness.

I came to know more about this field as an evaluator for the Partnership for Effective Community Response (PEER)-- a disaster preparedness coalition for the Greater Boston area. The PEER program was hosted by Boston University School of Public Health (BUSPH) and included representatives from hospitals, community health centers, emergency medical services, long-term care centers, and 62 cities and towns’ local health departments. PEER’s work centered on improving communications and response protocols, supporting mutual aid agreements, and offering necessary trainings. ICH served as the lead evaluator for the initiative, assessing the coalition’s processes and outcomes and providing technical assistance for PEER activities. Working on a number of these activities and interacting with our partners at BUSPH fueled my interest in delving deeper into emergency preparedness as a public health issue.

We often associate emergency preparedness with terrorist attacks, as the major American push for emergency preparedness came after 9/11 and the subsequent anthrax attacks. These events led the federal government to institute funding for states to support preparedness work for such disaster scenarios. However in 2004, the focus shifted from bioterrorism to an “all hazards” approach, involving preparation for common elements of all emergencies. Going beyond terrorist attacks, this approach encompassed preparedness for all natural disasters, mass casualties, chemical and biological threats. This approach centered on communities’ ability to meet the health care needs of their residents in the event of an emergency or disaster. As a result, the Assistant Secretary for Preparedness and Response (ASPR)with the passage of the Pandemic and all-Hazards Preparedness Act—was created to ensure that health care systems were prepared to meet these needs. As a part of this continuing effort, in 2012 ASPR and the Centers for Disease Control and Prevention (CDC) issued guidance for the establishment of multi-disciplinary health care coalitions, emphasizing that such partnerships are integral to emergency preparedness and strategy coordination for an “all-hazard” approach.

Massachusetts experienced a number of emergency situations over the past couple of years, including the Boston Marathon bombings, Hurricane Sandy, Nor’easters, and the influenza pandemics (H1N1 and swine flu), which  have heightened awareness about emergency preparedness across the Commonwealth. This heightened awareness has come at a time when MA is also refocusing its emergency preparedness strategies to include a more integrated approach and response that will enhance MA’s health and medical capacity across the disaster management cycle (planning, response, recovery, and mitigation). Creating cross-jurisdictional, multi-disciplinary health and medical coordinating coalitions (HMCC) will help to improve communication capacity between facilities during emergencies.

The Massachusetts Department of Public Health Emergency Preparedness Bureau (MDPH EPB), with assistance from BUSPH, is currently in the planning phase of establishing six HMCC’s in each of the hospital preparedness regions in Massachusetts: Region 1, 2, 3, 4ab, 5, and Boston. Each region’s HMCC will support preparedness and response efforts for the multiple public and private health and health care organizations, including acute care facilities, community health centers and other large ambulatory care organizations, emergency medical service providers, long-term care facilities, public health agencies, and other health care disciplines and public safety partners within each region. Staff from each HMCC will be able to provide coordinated support and response for affected individual agencies within its region during an emergency. ICH will once again be engaged as the evaluator for this coalition building, and I look forward to contributing to such a critical endeavor.

As the state continues to ensure appropriate systems are in place for emergency situations, it is important that we—public health professionals, practitioners, partners, and community members— follow MA’s lead and consider how our networks could be affected in an emergency. Especially as the fall and winter months approach, we should all take steps to ensure our communities, workplaces, and families are prepared.


The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.