Addressing Barriers to Colorectal Cancer Screening
Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States, despite the availability of high-quality screening options. Multiple barriers to CRC screening have been identified, including cost for the uninsured, younger age, racial or ethnic minorities, recent immigration to the United States (non-English speakers), fear or distrust of the health care system, and rural residence. This learning collaborative will explore barriers to CRC screening and identify interventions that can be implemented by health center programs serving at-risk populations.
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.
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.
Clinical Quality Group Diabetes and Staff Needs
On February 23 the Clinical Quality Working group, STAR² Center, and National Nurse-Led Care Consortium discussed diabetes and staffing needs in Public Housing Primary Care. People with diabetes have differing health care needs relating to their diabetes subsequently the diabetes workforce comprises a large multidisciplinary team spanning the health continuum and service providers with varying levels of expertise. As diabetes occurs across the lifespan and concomitantly with many other conditions, multiple services are required at different times or at the same time.
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.
Current and Emerging Issues in Public Housing Primary Care
Access to comprehensive, quality health care services is important for promoting and maintaining health, preventing diseases, reducing disabilities, and achieving health equity. On this call, Public Housing Primary Care Health Centers (PHPCs) and NCHPH discuss current and emerging issues in PHPC settings, including the two HUD’s most recent initiatives: Envision Center Demonstration and Smoke-Free Public Housing.
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: 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.
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.
Forging Community Collaborations
During this informative conference call, NCHPH and PHPC Health Centers discuss the most recent topics regarding public housing and public housing primary care, including Envision Centers, Smoke Free Public Housing, Chronic Disease Management and Integrated Care, and PHPC trends. PHPC leaders offer new perspectives and solutions to improve the health status of public housing residents.
HUD’s Smoke Free Rule: What Health Centers and Public Housing Agencies Need to Know
HUD’s rule banning smoking in public housing is an excellent opportunity for Health Centers and PHAS to forge collaborations and address the health care needs of those living in public housing. During this session, we will be exploring best practices and challenges PHAs faced to implement the rule as well as smoking cessation services provided by Health Center programs, and the opportunities to collaborate across agencies.
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.
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.
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.
Partnerships and Collaborations in PHPC Settings
On this call, PHPC Health Centers discuss the changing face of public housing, strategies to increase access to care in public housing primary care, and current and emerging issues affecting Health Centers located in and/or immediately accessible to public housing developments.
Smoking Cessation
Public housing residents are more likely to smoke and suffer from health conditions that are exacerbated by smoking and secondhand smoke exposure, such as asthma, diabetes, and COPD, compared to the general adult population. The National Center for Health in Public Housing (NCHPH) hosted a call as part of its learning collaborative on improving access to smoking cessation services for public housing residents. Participants discussed needs, challenges faced by PHAs during the implementation process and HCs shared smoking cessation services and best practices.
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.
The Use of CHWs in the Prevention of Teen Pregnancy and HPV Vaccine Promotion in Hispanic Adolescent Girls Living in Public Housing
Teen pregnancy and HPV vaccination continue to be a pressing issue for low-income populations. Human papillomavirus (HPV) is a common sexually transmitted infection which is the cause of several cancers, including cervical cancer, and genital warts. Although cervical cancer can be prevented through screening, this cancer persists in the US. More recently, HPV vaccination has the potential to decrease the burden of HPV-related disease among young HPV-unexposed adolescents. This learning collaborative will explore the role of community health workers in teen pregnancy prevention and HPV vaccine promotion in teenage girls living in public housing.
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.