Addressing Violence in Public Housing Communities: Genesee Health Systems, Flint, MI
Violence is a significant social determinant of health for public housing residents. Exposure to violence is higher in communities where there are limited economic opportunities, high concentrations of poverty and unemployed people, and limited access to health and social services. And experiencing violence of any type-physical, sexual, or psychological- is associated with increased risks of physical, mental health and behavioral health disorders. Therefore, effective violence prevention and intervention programs at Health Centers that are located in or immediately accessible to public housing developments are critical to improving health.
Addressing Violence in Public Housing Communities: OIC Medical, Rocky Mount, NC
Violence is a significant social determinant of health for public housing residents. Exposure to violence is higher in communities where there are limited economic opportunities, high concentrations of poverty and unemployed people, and limited access to health and social services. And experiencing violence of any type-physical, sexual, or psychological- is associated with increased risks of physical, mental health and behavioral health disorders. Therefore, effective violence prevention and intervention programs at Health Centers that are located in or immediately accessible to public housing developments are critical to improving health.
AMIGAS Cervical Cancer Prevention Program Learning Collaborative
The AMIGAS “Ayudando a Las Mujeres con Información, Guía y Amor para su Salud” or “Helping Women with Information, Guidance, and Love for Their Health” is an evidence-based, bilingual health education intervention program designed to train community health workers (CHW) or “promotoras” to increase cervical cancer screening rates among Hispanic women. According to the Centers for Disease Control and Prevention (CDC), the incidence rate of cervical cancer is highest among Hispanic women in the United States with over 2,000 new diagnoses reported each year.
Barriers for Achieving Glycemic Targets
Improved glycemic control in people with diabetes delays the onset and progression of severe microvascular complications of diabetes. Despite advances in pharmacotherapy and diabetes treatment devices and the emphasis placed on treatment adherence over the last decade, National Health and Nutrition Examination Survey (NHANES) data showed 45% of patients with diabetes did not achieve glycemic targets of <7%. Although some patients with diabetes may be undertreated (e.g., inappropriate treatment regimens, psychosocial issues that require adjustment in therapeutic targets), one reason for poor glycemic control is patients’ difficulty in following treatment prescriptions and recommendations for diabetes self-care. This collaborative addresses barriers for achieving glycemic targets and approaches and interventions that assist patients with managing diabetes.
Building an Effective Collaborative Care Team to Address Diabetes in Special and Vulnerable Populations: Tailoring Care for Social Context
This session focused on the necessary elements to develop a high functioning patient-centered team for diabetes prevention, management, and treatment in primary care. The session addressed the roles of all members of the team including the critical role of leadership and clinical champions to building an effective collaborative team. This session laid the groundwork for the full series by engaging participants in a discussion of how to tailor diabetes care for social context. The conversation focused on the key elements needed for treating diabetes in the primary care and community setting with an emphasis on team-based approaches to wellness.
Cervical Cancer Prevention: Communication Interventions and Peer Health Education
The incidence of human papillomavirus (HPV)–related cancers is more than 35,000 cases in the United States each year. Preventing high-risk HPV infection is the key to the prevention of cervical dysplasia and cancer. Barrier contraceptives, such as condoms, are only about 70% effective at preventing HPV transmission. Effective HPV vaccines have been available in the United States for several years but are underused among adolescents, the target population for vaccination. Interventions to increase uptake are needed. This learning collaborative explores the use of communication interventions and peer health education to increase cervical cancer screening and the use of the HPV vaccine.
Cervical Cancer Screening and Prevention
A cervical cancer prevention and control program comprises an organized set of activities aimed at preventing and reducing morbidity and mortality from cervical cancer. The program provides a plan of action with details on what work is to be done, by whom and when, as well as information about what means or resources will be used to implement the program. The achievement of the program is assessed periodically using a set of measurable indicators. The goal of any comprehensive cervical cancer prevention and control program is to reduce the burden of cervical cancer by reducing human papillomavirus (HPV) infections, detecting and treating cervical pre-cancer lesions, and providing timely treatment and palliative care for invasive cancer. Monitoring and evaluation (M&E) in any health program is conducted to ensure that the processes and systems are developed and adhered to in such a way that the deliverables are of good quality and maximize the benefits to the target population.
Culturally Competent Care Learning Collaborative
To assist Health Centers in the adoption of the CLAS Standards and to equip providers with the competencies that will enable them to better treat the increasingly diverse population, NCHPH will be offering a 4-part learning collaborative. The interactive sessions will cover the fundamentals of cultural competency, language access, and building community partnerships through a combination of case studies and didactic learning.
Developing the Role of Community Health Workers and other Support Staff in Diabetes Prevention, Treatment, and Follow-Up
Community Health Workers (CHW) have been shown to be especially successful reaching hard to access populations such as agricultural workers and their families as well as the homeless and residents of public housing. In this session, participants and faculty explored the role of CHWs in the diabetes care team. Case studies and real-world discussion provided examples of both effective and ineffective integration of CHWs into the clinical care team. Participants discussed the scope of practice and most effective roles for CHWs within the diabetes care team as well as the role of clinical champions and leaders in effectively mobilizing the skills of CHWs and other team members.
Diabetes and Eye Exams in Primary Care
The American Academy of Ophthalmology recommends that anyone with diabetes should receive a retinal exam every year. Early detection can reduce the risk of severe vision loss by 90% and significantly reduce long-term healthcare costs. Unfortunately, fewer than 50% of patients with diabetes get a diabetic eye screening annually. During this session NCHPH explored ways to prevent and limit the extent of DR in public housing primary care settings.
Diabetes Continuum of Care: Using Behavioral Health and Substance Use Disorder Integration to Address Older Adults with Cognitive Impairments and Diabetes
This is the second webinar in the continuation of our Diabetes in Special & Vulnerable Populations: A National Learning Series. Diabetes affects more than 30 million people in the United States. Multi-tiered efforts to prevent, treat and manage diabetes are critical in reducing the burden of diabetes, particularly for medically underserved racial and ethnic minority populations. In addition to higher prevalence, ethnic and racial minority patients with diabetes have higher mortality and higher rates of diabetic complications.
Diabetes Continuum of Care: Impact of Health Literacy on Patients’ Diabetes Management and Self-Care
NCHPH partnered with members of the Special and Vulnerable Population Diabetes Task Force to provide a Learning Collaborative (LC) addressing critical issues to improve diabetes control in health centers nationally. NCHPH provided expertise in public housing primary care and provided a more in-depth exploration of strategies, tools, and resources needed to create positive change in diabetes control among health center patients. The LC sessions also provided in-depth knowledge and skills in order to address the unique needs of people experiencing homelessness, residents of public housing, migratory and seasonal agricultural workers, school-aged children, older adults, Asian Americans, Native Hawaiians and other Pacific Islanders, LGBT people, and other vulnerable populations.
Diabetes: Culturally and Linguistically Appropriate Services
Minority groups are affected by diabetes at significantly greater rates when compared to non-Hispanic white Americans for reasons that are multidimensional. Diabetes educators need be mindful of the cultural traditions and customs among all cultural and ethnic groups and to recognize socio-economic challenges that may exist. When diabetes education programs are delivered using culturally appropriate methods in diverse populations, they can result in improved patient health behavior, knowledge, health status, and self-efficacy. During this session, NCHPH explored strategies to provide culturally and linguistically appropriate services to diabetic patients.
Empowerment and Self-Management of Diabetes – The Pharmacist and Diabetes Care Learning Collaborative
The goal of this learning collaborative is to discuss with pharmacists how to integrate diabetes education and management into practice, so patients can make the best use of their medications and achieve the desired therapeutic outcomes.
Expanding Diabetes Prevention and Management Through Health Center Outreach
In this training hosted by the National Center for Health in Public Housing, we addressed diabetes resources for CHWs, explained the roles and competencies of CHWs in diabetes prevention with an emphasis on nutrition, physical activity programs and other lifestyle interventions, and how CHWs can help patients with diabetes crack food insecurity and other social determinants of health through community resources.
This learning collaborative was comprised of a mix of outreach and diabetes educators from at least 10 health centers in or immediately accessible to public housing. Utilizing evidence-based models such as those developed by the Centers for Disease Control and Prevention (CDC), Community Preventive Services Task Force or National Health, Lung, and Blood Institute (NHLBI), the four learning modules allowed for the implementation of process for weight screening and tracking patients with abnormal BMI and HbA1c.
Exploring Cultural Competence & Humility in the Care of HIV Patients
This training was designed to help move organizations past cultural stereotypes and biases (e.g., based on race, sexual orientation, gender identity) to offer client-centered services with cultural humility. During this session NCHPH collaborated with the Southern AIDS Coalition (SAC) to provide participants the opportunity to better understand identity and diversity as we explored the long history of identity in the context of serving populations living with and/or impacted by the HIV/AIDS epidemic. Focus points for this session were also to provide a brief overview of PHPC grantee patients living with HIV.
Health for All – Increasing Inclusion for Patients with Disabilities
Previous research has indicated that individuals with physical or intellectual disabilities often struggle to access the resources and care necessary to live independent and healthy lives. Scholarship has also indicated that providers and supporters of these individuals often face frustration and burnout when they are unable to provide patients with the support they need.
In this 4-part learning collaborative, Dr. Kevin Lombardi MD MPH and the NCHPH research and clinical quality team facilitated a set of interdisciplinary and collective sessions designed to engage with the latest data, clinical/social guidance as well as recommendations from leading providers on how to maximally support individuals with disabilities.
Identifying and Treating People with Prediabetes
Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. According to the Center for Disease Control and Prevention (CDC), approximately 84 million American adults—more than 1 out of 3—have prediabetes. Of those with prediabetes, 90% don’t know they have it. In this session participants discussed statistics of prediabetes and conversion rates from prediabetes to diabetes, identify patients at risk for diabetes, resources to screen and test for prediabetes and the use of EHRs to identify people with prediabetes.
Improving Cultural Competency for Behavioral Health Professionals Serving Residents of Public Housing
Behavioral health services form a crucial part in providing quality health care services, particularly to populations of diverse cultural backgrounds living in public housing. Behavioral health services that adhere to cultural competency have shown to engender more positive health outcomes such as better adherence to medications and treatments, building trust between healthcare providers and their patients, and has contributed to the creation of more sustainable ways of providing care to patients overall.
To assist Public Housing Primary Care (PHPC) Health Centers grantees in increasing their capacity to provide quality behavioral health services to patients from diverse cultural backgrounds, NCHPH will be conducting a 5-part learning collaborative. This learning collaborative will focus in helping behavioral health professionals increase cultural and linguistic competency.
Improving Cultural Competency for Behavioral Health Professionals 2022
In this learning collaborative we presented cultural competency as a data-driven method to improve patient care and health center performance in multiple domains through responsible application of scientifically validated tools and processes. Throughout the collaborative we took a detailed look at key concepts regarding culture as a SDOH. This includes an overview of the literature and key developments in the field. Additionally, we engaged in a collective and reflective approach of cultural competency as it pertains to clinical practice to develop our understanding of both our patient’s and our own cultural background. Finally, critically inspected and reviewed validated screening tools, explored their practical application in difficult situations and put them into action with volunteer patient actors.
Kids, E-Cigarettes, Vaping, and New Tobacco Products
E-cigarettes and vaping devices have become an almost ubiquitous – and dangerous – trend among youth that has reached epidemic proportions. Over the past several years, e-cigarettes were the most commonly used tobacco product by youth. In fact, more than 2 million middle and high school students were current users of e-cigarettes in 2017. Health Centers and community organizations will have to develop campaigns and put resources to educate youth that using e-cigarettes, just like cigarettes, puts them at risk for addiction and other health consequences because nicotine can rewire the brain to crave more nicotine, particularly because adolescent brains are still developing. In addition, e-cigarettes, among other things, can contain dangerous chemicals such as: acrolein, a chemical that can cause irreversible lung damage; formaldehyde, a cancer-causing chemical; and toxic metal particles, like chromium, lead and nickel, which can be inhaled into the lungs.
Management, Education and Support, Nutrition, Physical Activity, Smoking Cessation, and Psychosocial Issues
Residents of public housing are particularly at risk of developing diabetes and diabetes-related complications due to the many social factors that impact their health. A recent HUD publication indicates that HUD-assisted adults have the highest prevalence of diabetes diagnosis, with 17.6% reporting ever having been told they had diabetes. During this session NCHPH explored ways to manage diabetes through programs that address education and support, nutrition, physical activity, smoking cessation, and psychosocial issues.
Microvascular Complications and Foot Care
The importance of protecting the body from hyperglycemia cannot be overstated; the direct and indirect effects on the human vascular tree are the major source of morbidity and mortality in both type 1 and type 2 diabetes. Diabetes complications are divided into microvascular (due to damage to small blood vessels) and macrovascular (due to damage to larger blood vessels). In this session, we discuss diabetes barriers to care and best practices to address microvascular complications among diabetic patients.
Nonadherence and Behavior Change: How are You Helping your Patients?
Research studies indicate that diabetes affects around 9% of the U.S. population, and it is a leading cause of heart disease, stroke, kidney failure, lower limb amputations, and blindness among U.S. adults. A recent CDC publication estimated direct medical costs attributable to this disease were $116 billion, and the number of patients with diabetes will more than double by 2050. Thus, diabetes is a highly prevalent disease that is important for both public health and public policy reasons.
Patient Engagement Strategies for the Collaborative Care Team: Group-Visits
Pre-visit planning includes scheduling patients for future appointments at the conclusion of each visit, arranging for pre-visit lab testing, gathering the necessary information for upcoming visits and spending a few minutes to huddle and handoff patients. This can be particularly challenging for vulnerable populations such as agricultural workers, the homeless and residents of public housing. This session will explored strategies and tools for diabetes pre-visit planning that can be successful for vulnerable populations. Participants and faculty brought case studies and real life scenarios to the discussion in order to facilitate problem-solving conversations about how to address challenging scenarios. The session also addressed how to best incorporate pre-visit planning into a team-based setting that includes CHWs.
Patient Intervention Strategies for the Collaborative Care Team: Pre-Visit Planning
Group visits have been shown to be an effective strategy to address diabetes management in a number of health settings. During group visits, participants have a greater opportunity to ask questions, run the discussion and provide one another with peer support. CHWs can be particularly effective in setting up and helping run group visits at health centers. During this session, participants discussed different models for group visit and explored best practices used in health centers. The session relied on case studies and real-life scenarios to discuss challenges and successes using group visits with vulnerable populations.
Phases of Diabetes Care
Diabetes care can be organized into three phases: pre-visit, intra-visit, and post-visit. Opportunities exist during each phase to introduce practice changes that can help engage and support patients in their diabetes care and management. Health care teams can optimize diabetes encounters by taking a planned, continuous improvement approach to visits, which includes pre-visit preparation (by both patients and practices), intra-visit coordination (among practice team members), and post-visit follow-up (among the practice team and with patients).
Screening for the Social Determinants of Health: An Epidemiological Perspective
There is increasing interest in integrating the Social Determinants of Health (SDOH) into clinical practice. When appropriately utilized, screening for SDOH provides measurable benefits to clinicians, patients, and health center management. In this learning collaborative by NCHPH, we presented the SDOH as an epidemiological framework that maximizes the patient and the health center experience. We examined the research behind SDOH policy/protocol implementation and reviewed screening tools that provide the best benefit to patient and clinician in various contexts.
Social Determinants of Health Screening Tools for Public Housing Residents
In this learning collaborative, NCHPH guided participants through the practical aspects of identifying and implementing an SDOH screening process at their health center. The series went beyond the basics by covering issues such as:
• building trust while assessing social risks;
• integrating data to improve patient engagement;
• evaluating impact on patient outcomes and health center procedures;
• understanding the variability and utilization of specific screening tools that are dependent on the context of health issues;
• reimbursement and funding strategies to pay for SDOH screening and referrals.
Each session included insight and promising practices from an expert in the health care field.
Strategies for Diabetes Awareness, Prevention and Control: Focusing on Prediabetes
Increasing awareness and risk stratification of individuals with prediabetes may help physicians understand potential interventions that my help decrease the percentage of patients in their communities in whom diabetes develops. During this session NCHPH discussed strategies for diabetes awareness, prevention and control with a focus on Prediabetes.
Supporting Implementation of Smoking Cessation Programs in Public Housing Primary Care Settings 2020
This Learning Collaborative aimed to identify barriers to implementation of and strategies to establish smoking cessation programs in primary care settings through a series of four sessions: a didactic webinar, covering the behavioral aspects of cessation counseling, the FDA approved medications for cessation and some basic motivational interviewing techniques, and a subsequent three learning collaborative sessions, detailing how to conduct each counseling session whether they are individual or group. NCHPH provided a written protocol booklet to be used as a guide during actual sessions.
Supporting Implementation of Smoking Cessation Programs in Public Housing Primary Care Settings 2021
This NCHPH Learning Collaborative discussed ways to debunk the myth that smoking is an effective way to deal with stress, enumerated various proven stress management techniques, in depth, that can be used to maintain a quit, and discussed how to successfully teach these techniques to patients.
Using Information Systems and Technology to Enhance Diabetes Care
Patients and physicians require new tools to manage the growing burden of chronic illness. For providers responsible for the care of diabetic patients, developments in information management, real-time health education and feedback, and new approaches to self-monitoring and insulin delivery hold great promise to improve the quality and safety of diabetes care. In this call, NCHPH and Health Centers participants shared some of the major developments in the field, and the ways these technologies can be integrated into a typical practice.
Violence and Opioid Abuse in Public Housing Communities
During this presentation, NCHPH highlighted the problems, solutions and opioid overdose training related to public housing residents. An overview of the likelihood of opioid abuse and the long-term effects on children due to violent experiences was provided in addition to a detailed description of the methodology behind NCHPH’s case study on Addressing Violence in Public Housing Communities. NCHPH also presented on case examples on what health centers are doing to mitigate the effects of violence and opioid abuse in public housing communities.
Women’s Health Program: San Ysidro Community Health Center
Women’s Health Programs provide an excellent opportunity to counsel patients about preventive care and to provide or refer for recommended services. These assessments should include screening, evaluation and counseling, and immunizations based on age and risk factors. In this interview, San Ysidro Community Health Center shares the activities that are part of their Women’s Health Program.
Women’s Health Program: South Boston Community Health Center
Women’s Health Programs provide an excellent opportunity to counsel patients about preventive care and to provide or refer for recommended services. These assessments should include screening, evaluation and counseling, and immunizations based on age and risk factors. In this interview, South Boston Community Health Center shares the activities that are part of their Women’s Health Program.