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.

Thursday, October 3, 2013

ICH and Agenda for Children: Demonstrating Program Impact

By Kat Xu, MPH

In April 2013, Cambridge was one of six communities awarded the inaugural Robert Wood Johnson Foundation’s “Roadmaps to Health Prize” for developing innovative strategies to improve community health.One of the featured Cambridge community partnerships was the Agenda for Children (AFC) Literacy Initiative.

In 2002, The AFC Literacy Initiative launched the “Let’s Talk…It makes a difference” campaign, which aims to help children enter school primed to succeed by providing parents and caregivers with knowledge, skills and materials to support their children’s language and literacy development. This program offers an array of services and activities for families with children ages birth to 5 years old, all of which stress that parents are their children’s first teachers. Free workshops help parents learn the importance of talking, interactive reading, and storytelling and provide practical techniques to encourage high-quality parent-child verbal interaction. The program also provides home and maternity ward visits, book distributions, and playgroups.

ICH’s Partnership with AFC
Since the Let’s Talk campaign’s inception, AFC has partnered with ICH to support their continuous program improvement efforts. ICH provides ongoing evaluation assistance using a participatory approach. ICH and AFC staff work together to implement evaluation activities, including fidelity checklists and activity logs for the Literacy Ambassadors, Talk Workshop and Reading Party surveys, and telephone interviews with a sample of home visit participants. ICH and AFC staff’s close collaboration allows the evaluation findings to critically impact program enhancement and sustainability by highlighting the program’s effectiveness and community impact. 

"We've worked with the Institute for Community Health for many, many years. They provide incredible knowledge and expertise beyond what we have available at our organization. They have worked with us to tailor our evaluation efforts, so that the results are useful and can guide decisions about programmatic changes.  We also have used the results of our evaluation efforts to illustrate program outcomes and successes.”
- Jen Baily, Agenda for Children Program Coordinator

Let’s Talk Campaign Produces Results
Literacy Home Visit Participants (n=170)

Cumulative results from 2007-2011 reveal that the program is having a profound impact on Cambridge children and families. Through surveying parents after the talk/read workshops and home visits, we found that parents increased their knowledge of the importance of talking and reading with their children and demonstrated significant behavioral changes around talking and reading with their children at least 1 month to 3 months after the home visits.  

Supplementing the quantitative data, our interviews with parents revealed a more complete picture of the program’s importance to the community. Parents mentioned:

  • Increased social connectedness through information and resources
  • Stronger parent-child engagement through talking and reading with children 
    • “(I learned that) It's important to have a connection and listen to your babies so you can know what their needs are.”
  • Learning and adapting new techniques to talking and reading (e.g. calmer tone, storytelling with picture books, having conversation with child and asking questions)
  • Gaining emotional support from home visits
    • “Sometimes as a new mom, it can be isolating, so having a home visitor was a nice change.”
  • Feeling encouraged to communicate with their children in English and in their native language
  • Seeing their child grow and change (e.g. more engagement through talking and increased interest when reading)

Agenda for Children is improving Cambridge’s community health by working to ensure all of its children are literate.  Because many Cambridge families have multiethnic or immigrant backgrounds, AFC’s multilingual and multicultural staff are crucial for improving literacy and connecting families with community resources.  ICH’s long partnership with the AFC Literacy Initiative has been a fruitful one, as we have seen how our program evaluation support has helped AFC progress and make a significant impact 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.

Wednesday, October 2, 2013

Learning About My Community Through Data: Reflections on My Summer at ICH

By Grace Chan

Tufts University MS in Nutrition/MPH Candidate

My summer as the Data Analyst Intern at the Institute of Community Health (ICH) has been an enriching experience. ICH has provided me insight into the world of quantitative data as well as taught me more about the communities surrounding metro-Boston – both aspects I wanted in a summer internship.
Before joining ICH in May, I finished my first year of graduate school at Tufts University.  As a MS Nutrition/MPH student, my goal is to gain more knowledge about the role of nutrition interventions in preventing chronic diseases. I want to gain skills in epidemiology and biostatistics in order to understand the complex interactions between nutrition, environmental exposures, and health behaviors that lead to various health outcomes. Having lived in Boston for less than a year, I decided to stay here to complete my summer internship rather than go home to California, in order to learn more about the community I am now a part of.

I first heard about ICH through a course at Tufts.  I was intrigued by the work ICH does in collaboration with local communities, and was excited to see a data analyst internship position available for the summer.  At ICH, I have had the pleasure of working on the Everett Data Book Project with Lisa Arsenault, Blessing Dube, Kelly Washburn, and Reann Gibson.  We worked with the Everett community representatives, Jean Granick, Bob Marra, and Jamie Stein, to compile a health assessment data book, detailing the health of the community’s adult and youth populations. Once completed, the data book can be used to inform the development of community programs and promote policy change.

During the internship, I learned to access data from various sources, such as MassCHIP, the Massachusetts Department of Education, and the Bureau of Labor Statistics.  Furthermore, I learned to analyze surveys such as the Youth Risk Behavior Survey (YRBS) and the Behavioral Risk Factor Surveillance System (BRFSS).  I gathered data of interest to the community members from these sources, organized and cleaned the data, and created charts that display the information in usable and meaningful ways.  Additionally, I participated in meetings with the Everett community representatives and made further improvements to the charts based on their feedback.  My team gave me a lot of support and guidance, plus the independence to explore the data and create charts from information I believed the community would find important.  They also offered me opportunities to present the data, most notably, to the larger work group in Everett that represents various sectors in the community.
As I reflect on my time at ICH, I know that I’ve gained valuable knowledge and skills that I will use in my future endeavors.  For example, I am more comfortable working with (and less intimidated by) large data sets.  Also, I developed a keener eye for detail and gained lots of experience working in Microsoft Excel.  Most importantly, I experienced collaborating with community members whose insights give more meaning to the data.  Overall, I am glad to have spent my summer with the wonderful members of my team.  I enjoyed getting to know my ICH team members and the Everett community.  It has been rewarding to be able to contribute to the process of creating the data book, and I cannot wait to see the final product!
Learn about the ICH Internship Program

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.